Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning.
Two cases of fatal oral poisoning are presented. In the first case, a 40-year-old man died due to a lethal dose of mercury (blood concentration 113.8 microg/ml) and in the second, a 34-year-old man died of chloralhydrate overdose with a lethal blood concentration of trichloroethanol (52 microg/ml), the active metabolite of chloralhydrate. In both cases gross examination and histology showed an unusually well preserved gastrointestinal mucosa in addition to unspecific signs of intoxication. The two cases demonstrate that the phenomenon of perimortal fixation is a useful indication for the forensic pathologist and should direct the suspicion to oral poisoning. The detection of fixation facilitates toxicology screening by indicating that the relevant substance must have the capability to precipitate proteins.
Sperhake
J
J
Institute of Legal Medicine, University of Hamburg, Butenfeld 34, D-22529 Hamburg, Germany. sperhake@uke.uni-hamburg.de
Tsokos
M
M
Sperhake
K
K
D000328:Adult; D002697:Chloral Hydrate / Q000032:analysis / Q000506:poisoning*; D004386:Duodenum / Q000187:drug effects* / Q000473:pathology; D005023:Ethylene Chlorohydrin / Q000031:analogs & derivatives / Q000032:analysis; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008630:Mercury Poisoning / Q000473:pathology*; D011041:Poisoning / Q000473:pathology*; D011180:Postmortem Changes; D012680:Sensitivity and Specificity; D016707:Tissue Fixation
D002697:Chloral Hydrate; D005023:Ethylene Chlorohydrin; C005849:2,2,2-trichloroethanol