Death in custody due to a colopericardial fistula.

Death while in custody is a sensitive issue as it has the potential to cause legal ramifications and political fall-out, to embarrass the law enforcement community, and to incite the general population. Studies of deaths while in custody show that natural deaths are much more common than both suicides and homicides combined. Studies also indicate that natural deaths cluster in the older population, while suicides, on the other hand, occur predominantly in the younger population. We present a summary and discussion of a death in custody that is unique in several aspects. Contrary to the norm, death in this 18-year-old male inmate was natural. It was due to a rare complication (colopericardial fistula) of a surgical procedure (colonic interposition) performed roughly 16 years previously. We believe that our case represents the third example of a colopericardial fistula and the first to occur following corrective surgery for esophageal atresia.