title: Homicide or suicide? Xylophagia: a possible explanation for extraordinary autopsy findings.
abstract: Determining the cause of death and differentiating self-inflicted injuries from non-self-inflicted injuries is a primary goal in legal medicine. Especially with unidentified decedents, autopsy findings alone are often not sufficient; there is no knowledge of pre-existing conditions and only circumstantial evidence is available from the scene of death. In our case, radiological, histological, and toxicological examinations provided an explanatory model for extraordinary autopsy findings consistent with pica, a rare eating disorder. In cases of pica, variable and potentially lethal complications emerge, depending on the type and amount of material ingested. Our case is of an apparently uncontrolled intake of wooden objects (xylophagia). The resulting mechanical damage to the gastrointestinal tract and subsequent soft tissue damage supports that this behavioral disorder is not only of medical concern, but also identifies it as a mental disease with medico-legal relevance.
authors.affiliation: Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany, anke.klein@uke.de.
authors.forename: Anke
authors.initials: A
authors.lastname: Klein
authors.forename: Carolin
authors.initials: C
authors.lastname: Schröder
authors.forename: Axel
authors.initials: A
authors.lastname: Heinemann
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
mesh_terms: D001344:Autopsy; D001706:Biopsy; D002423:Cause of Death; D017809:Fatal Outcome; D005547:Foreign Bodies; D006708:Homicide; D006801:Humans; D008297:Male; D010842:Pica / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013405:Suicide; D014057:Tomography, X-Ray Computed; D014934:Wood; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology
references.citation: Psychiatry Clin Neurosci. 2010 Aug;64(4):444
references.pmid: 20653915
references.citation: Neurology. 1983 Sep;33(9):1141-5
references.pmid: 6684248
references.citation: Singapore Med J. 2004 Oct;45(10):487-8
references.pmid: 15455170
references.citation: Am Fam Physician. 1986 May;33(5):181-5
references.pmid: 3486579
references.citation: Arch Kriminol. 1975 Nov-Dec;156(5-6):160-8
references.pmid: 1227422
references.citation: J Laryngol Otol. 1999 Aug;113(8):769-71
references.pmid: 10748860
references.citation: Br J Psychiatry. 1985 Mar;146:255-61
references.pmid: 3857097
references.citation: Chirurg. 2003 Jul;74(7):626-31
references.pmid: 12883789
references.citation: Br J Surg. 1978 Jan;65(1):5-9
references.pmid: 623968
references.citation: Br J Psychiatry. 1992 Mar;160:341-54
references.pmid: 1562860
references.citation: Br J Psychiatry. 1985 Jul;147:80-2
references.pmid: 2933113
references.citation: J Am Acad Psychiatry Law. 2012;40(1):119-26
references.pmid: 22396349
references.citation: Am J Med. 1994 Oct;97(4):390-3
references.pmid: 7942944
references.citation: J Clin Psychiatry. 2007 Apr;68(4):604-10
references.pmid: 17474817
references.citation: Acta Medica (Hradec Kralove). 2011;54(2):91-3
references.pmid: 21842726
references.citation: Laryngorhinootologie. 2009 Apr;88(4):253-6
references.pmid: 19347783
references.citation: J Am Board Fam Pract. 2000 Sep-Oct;13(5):353-8
references.pmid: 11001006
references.citation: Behav Res Ther. 1993 Mar;31(3):315-20
references.pmid: 8476406
references.citation: Nature. 1999 Jul 8;400(6740):120-1
references.pmid: 10408435
references.citation: Am J Clin Nutr. 1991 Feb;53(2):448-56
references.pmid: 1989412
references.citation: Child Abuse Negl. 2007 Jun;31(6):615-21
references.pmid: 17617455
references.citation: Gastrointest Endosc. 1993 Sep-Oct;39(5):626-30
references.pmid: 8224682
references.citation: Med Sci Law. 2006 Oct;46(4):357-9
references.pmid: 17191641
references.citation: Int J Adolesc Med Health. 2005 Jul-Sep;17(3):295-7
references.pmid: 16231483