Abstract
Massive aspiration of food is rare, but most common in people under the influence of alcohol or a drug and comatose patients who have impaired functioning of the central nervous system. The finding of small amounts of food material in the airway at autopsy does not indicate the true vital aspiration because of agonal or even early post-mortem overspills. Occlusion of the small airways, mainly the membranous and respiratory bronchioles, partial or total filling of bronchiolar lumen and the alveolar spaces with food or gastric content were typical morphologic findings. In our 10 year retrospective study we presented the data of 21 male and 4 female cases with a final diagnosis of fatal aspiration in age from 23 to 78 years (45.43±14.61) from the records of Morgue Specialization Department of the Council of Forensic Medicine. 13 cases found death at the scene without an eyewitness. All deaths were accidental in manner except one homicide. Toxicological analysis revealed blood alcohol concentration levels between 161 and 339 mg/dL in 7 cases. Morphine metabolites, benzodiazepine and barbituric acid derivatives, toluene and acetone were detected in 5 subjects. Aspirated materials were food in 14 cases, chewing gum in 3 cases, gastric content in 7 cases and a fabric gag in one case.The history, other evidence of external vomit on the clothing or immediate surroundings and toxicological analysis are by no means as significant as autopsy findings especially in cases of aspiration.Key words : adult; aspiration; death; autopsy
Highlights
The aspiration of a wide variety of materials causes mechanical asphyxia as a result of obstruction of the airways
Aspiration of food material or gastric content in a different extent can be observed in a great number of criminal, accidental and suicidal deaths, and in a wide range of deaths from natural causes
Gastric content is commonly found in the larynx, trachea and bronchi at autopsy and the differentiation between agonal or even postmortal overspill from true vital aspiration without clinical or other witnessed evidence is difficult and sometimes impossible [3,4]
Summary
The aspiration of a wide variety of materials causes mechanical asphyxia as a result of obstruction of the airways. The impaction of a bolus of food or some other foreign body in the larynx leaves no doubt about the cause of death. This is rare, but most common in people under the influence of alcohol or a drug and comatose patients who have impaired functioning of the central nervous system. Aspiration of food material or gastric content in a different extent can be observed in a great number of criminal, accidental and suicidal deaths, and in a wide range of deaths from natural causes. Gastric content is commonly found in the larynx, trachea and bronchi at autopsy and the differentiation between agonal or even postmortal overspill from true vital aspiration without clinical or other witnessed evidence is difficult and sometimes impossible [3,4]. The significance of small amounts of food material in the airway at autopsy is low, but occlusion of the small airways, mainly the membranous and respiratory bronchioles, partial or total filling of bronchiolar lumen and the alveolar spaces with food or gastric content are typical morphologic findings [5]
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