Forensic Science, Medicine and Pathology最新文献

Non-occlusive mesenteric ischemia (NOMI) is an acute form of intestinal ischemia that occurs in the absence of organic stenosis of the mesenteric arteries. Vasoconstrictive agents have been recognized as potential etiological factors. This report describes the first documented Japanese autopsy case of NOMI induced by methamphetamine (MA), a potent sympathomimetic agent. A forensic autopsy was performed on a man in his 60s who died suddenly. Gross and histopathological findings of the small intestine and mesenteric arteries were examined, and post-mortem toxicological analysis was performed to quantify the blood MA concentration. Autopsy revealed a dilated small intestine without mechanical obstruction, accompanied by non-contiguous ischemic necrosis and no signs of organic stenosis in the mesenteric arteries. Histopathological examination of the small intestine showed hemorrhage and necrosis, consistent with a diagnosis of NOMI. The blood concentration of MA was within the toxic range but below the fatal threshold, suggesting a causal relationship between MA use and the onset of NOMI. Given the fatal outcome despite an MA concentration below the reported fatal range, prolonged mucosal exposure from oral ingestion may have locally intensified vasoconstrictive effects, contributing to intestinal ischemia. This case highlights the importance of considering MA-induced NOMI in the differential diagnosis of sudden death among MA users and highlights the risk of fatal ischemic complications even at non-fatal MA concentrations.

As with all traumatic pathologies, determining when a fracture occurred and during which event it occurred is necessary for an accurate medicolegal evaluation. Among the 4,224 cases for which forensic reports were prepared, the report outcome changed in 105 cases (2.5%) when prior medical imaging was included in the medicolegal evaluation. In the initial assessment of the cases (based on emergency department medical records and radiology reports), a bone fracture was recorded in 59.0% of the cases, no bone fracture in 10.5%, and a suspected bone fracture in 30.5%. In the final evaluation-conducted by the forensic medicine outpatient clinic-where current medical images were compared with prior medical images, it was determined that a bone fracture had occurred in the most recent trauma in 17.1% of the cases, that no new fracture attributable to the most recent trauma was present in 79.1%, and that new fractures in addition to old bone fractures were present in 3.8%. We believe that, when analysing current medical images, the search for prior medical imaging and the comparative analysis of obtained prior images with current images should be a routine component of medicolegal evaluation for all forensic cases, regardless of case type.

Pregnancy in a rudimentary horn is rare but can lead to severe complications, including life-threatening complication like rupture of the rudimentary horn. Herein, we report a case of maternal death due to massive hemorrhage from a ruptured non-communicating rudimentary horn pregnancy. A 26-year-old female died at home after experiencing severe abdominal cramps three hours prior to her death. She contemplated seeking medical attention at the beginning of her cramps but decided to wait as her pain initially subsided. Tragically, her condition worsened suddenly, and she collapsed before accessing medical care. The autopsy revealed approximately 4,000 ml of blood in the abdominal cavity, with significant clots lining the mesenteric surface of the colon. A dead fetus, measuring 18 cm in crown-to-heel (CHL), attached to the placenta, was discovered in the left paracolic gutter. Based on the CHL measurement, the fetal gestational age was estimated to be around 4 months. There was a ruptured rudimentary uterine horn connected to a centrally located unicornuate uterus by a non-communicating fibrous band. The unicornuate uterus had a normal mucosal surface and was continuous with the cervix and vagina. This case highlights the tragic consequences of delayed presentation during acute medical conditions of pregnancy, and underscores the importance of patient education regarding symptom recognition and seeking care. It also emphasizes the importance of considering ruptured rudimentary horn pregnancy as a potential cause of maternal mortality especially in cases of sudden and unexplained deaths in women of reproductive age group, even when pregnancy is not immediately apparent. Thorough forensic evaluations and reporting are crucial in maternal deaths to identify such rare but fatal conditions.

Black esophagus (BE) is a rare finding characterized by a black appearance on the distal esophageal mucosa. In the forensic field, BE is often reported in cases of diabetic ketoacidosis and hypothermia. Coexistence of acute duodenitis (black duodenum) has also been reported. Serious complications, such as esophageal perforation and hemorrhagic shock from bleeding from the esophageal mucosa, can be life-threatening. We report a forensic autopsy case of a relatively young man who died of BE and black duodenum with no underlying conditions such as diabetes or alcohol/drug abuse. The patient was a 44-year-old man with a history of depression. He was found dead at home two days after visiting the doctor with vomiting and stomach pain. Internal inspection revealed stomach content of 1500 mL of black hematinized fluid. Black discoloration of the distal part of the esophageal and black discoloration on the duodenal mucosa, and pallor of the internal organs were observed. Blood acetone was 16 µg/mL and hemoglobin A1c was 5.6%. No alcohol was detected in the cardiac blood. The cause of death was considered to be exsanguination from the BE and black duodenum. Because the patient had presented with vomiting two days prior to death, the cause of the BE was considered to be esophageal mucosal injury due to vomiting or ischemic insult to the esophagus from dehydration. Although a large proportion of the causes of death in BE cases are associated with underlying medical conditions, forensic pathologists should keep in mind that BE itself could be life-threatening.