Forensic Science, Medicine and Pathology最新文献

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.

Drowning is a common cause of death encountered in forensic practice, typically with clearly defined circumstances and mechanisms. However, in rare cases, the dynamics of death may be atypical and require a multidisciplinary evaluation. We present a highly unusual case of an 18-year-old male who drowned following the administration of fluids during a state of deep unconsciousness induced by fatal methamphetamine intoxication. The case illustrates how passive aspiration of fluids during deep unconsciousness with absent airway protective reflexes, inferred from toxicological levels (blood methamphetamine 4,818 ng/mL) and the observed clinical scenario, can result in drowning, particularly in the context of acute drug-induced neurological and cardiovascular suppression. The findings include typical autopsy signs of drowning and toxicological evidence of lethal levels of methamphetamine. The case highlights how scene statements, autopsy, toxicology, and diatom analysis jointly steer the assessment of criminal liability.