Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as "caput medusae." Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.

Sudden and Unexpected Death During Sexual Activity, Due to a Glial Cyst of the Pineal Gland.

Cysts of the pineal gland are benign lesions. Often asymptomatic, in the majority of cases they are discovered incidentally during brain magnetic resonance imaging or autopsy. Sporadically, however, they may cause such symptoms as chronic headache, loss of consciousness, corticospinal and sensory impairment, and, in some cases, even sudden death. A 45-year-old woman, in apparently good health, collapsed and died suddenly, after reaching orgasm while engaged in sexual intercourse. According to the circumstantial account of her relatives, the woman suffered from severe headaches, which were exacerbated by certain types of physical strain, such as sexual activity. Postmortem examination revealed no external injuries or internal diseases except for a cystic lesion of the pineal gland. Microscopically, the wall of the cyst consisted of a layer of glial tissue surrounded by an area of pineal elements. A complete forensic approach concluded that the cause of death was fatal cardiorespiratory failure resulting from midbrain compression due to a nonneoplastic pineal gland cyst, exacerbated by sexual activity. In this case, the intracranial pressure increase, secondary to Valsalva maneuver during climax, may further aggravate compression on the brainstem, thus concurring to determine the death.

Sudden Death Secondary to an Undiagnosed B-Cell Lymphoma of the Hypopharynx and Infiltration of the Inferior Constrictor Muscle.

The aim of this presentation was to share an uncommon form of sudden death, suffered by a 64-year-old woman, due to a mechanical obstruction of hypopharynx by an undiagnosed B-cell lymphoma, infiltrating the inferior pharyngeal constrictor muscle. A forensic approach by means of scene investigation, circumstantial data collection, autopsy, and histological and toxicological investigations led to conclude that the cause of death was asphyxia, correlated with B-cell lymphoma of the hypopharynx. The autopsy examination highlighted the presence of a wall thickening, infiltrating, and projecting into the hypopharynx lumen. The histological analysis showed the essential finding of a B-cell lymphoma of the hypopharynx, diffusely infiltrating the inferior pharyngeal constrictor muscle. To conclude, this case demonstrates once more that in the absence of specific data, a thorough forensic investigation including autopsy, histological examination, and circumstantial data collection is mandatory to reach a correct cause of death.

First records of Synthesiomyia nudiseta (Diptera: Muscidae) from forensic cases in Italy.

The knowledge of the fauna associated with carrions and cadavers for a specific region plays a fundamental role in the estimation of the time since death in forensic cases. In the last years global warming and globalization have affected the insect species distribution. This phenomenon is affecting also the species of forensic interest associated with the cadaver decomposition. The species distribution shift, in the forensic context, has been mainly observed in Diptera of different family: Calliphoridae, Stratiomyidae and Phoridae. In the last decade the presence of the carrion feeding species, Synthesiomyia nudiseta (Diptera: Muscidae), was reported from forensic cases in Spain and in the last year from Italy where the species was collected from 5 bodies in different decomposition stages in the Genoa district. All the records concern indoor cases with the presence of other species belonging to the first colonization waves (e.g. Calliphoridae, Sarcophagidae). Different hypothesis about the presence of the species in Italy can be suggested, but the molecular analysis and the importation records support the introduction trough commercial exchanges with Asian countries instead of a variation in the species distribution area from the Iberian Peninsula.

Self-Strangulation Through A Sphygmomanometer: An Uncommon Suicide.

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16-year-old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self-strangulation by means of an atypical item. The victim suffered from attention-deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self-strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.

An unusual and fatal case of upper gastrointestinal perforation and bleeding secondary to foreign body ingestion.

We report a fatal case of gastrointestinal perforation and hemorrhage secondary to the ingestion of a foreign body. While engaged in an amateur futsal competition, an apparently healthy young man suddenly collapsed and his respiration ceased. Autopsy revealed a 3-mm circular perforation on the gastric wall fundus with a significant amount of clotted blood within the gastric lumen. On inspection, a foreign body consisting of a bristle-like hair, later identified via electron microscopy to be a cat vibrissa, i.e. a whisker, was found along the perforation margin. Thus, the inadvertent ingestion of fine, sharp objects (even a cat whisker) can lead to gastric perforation and bleeding, which might prove fatal under given circumstances.