"When something goes wrong".

Background: Aspiration of food or liquids can result in suffocation, evolving in coughing, difficulty breathing and forced exhalation. Asphyxia occurs when the aspirated material occludes the upper airways, either in the proximal or distal tract, resulting in the inability to breathe. The risk of asphyxiation death, is increased if a person makes sudden movements while eating, walks or runs while eating, or even becomes distracted or frightened. It is higher in individuals with neurological diseases, intellectual disability (ID), cognitive impairment, psychiatric pathologies or their pharmacological treatments and people carrying additional physiological impairments, which can cause oral dysfunction and dysphagia. Protective mechanisms may sometimes lack or fail to expel food fragments stuck in the airways, which completely obstruct them.

Case series: The authors present some peculiar cases of subjects who died from food bolus choking, namely a case of mozzarella-cheese clogging in a young subject (25 years old) undergoing rehabilitation treatment following a stroke; a 38-year-old man with middle-grade mental retardation died from first airway food bolus (mush of bread) clogging; a 26-year-old subject with epilepsy died from tripe clogging in the course of a seizure; a 38-year-old subject in psychiatric treatment for depressive disorder who died from clogging with octopus tentacles.

Conclusion: Food bolus clogging asphyctic deaths generally occur in subjects with psychic/neurological pathologies, resulting in altered deglutition mechanisms or lack of protective reflexes. Foodstuff, especially if large or viscous, obstruct the proximal or distal airways, leading to acute respiratory failure and death. Autopsy is diriment in ascertain the cause of death.