Microscopic evidence of previous trauma to the hyoid bone in a homicide involving pressure to the neck.

Post-mortem examination of a female homicide victim suggested a fracture of the larynx and increased flexibility, without associated hemorrhage, of the hyoid bone. There was a history of domestic violence, which included an allegation of attempted strangulation. Microscopy confirmed a recent fracture of the larynx and showed evidence of a healing fracture in the hyoid bone. Death was due to multiple blunt force trauma, including pressure to the neck. The deceased's partner admitted strangulation and was convicted of murder. The discussion concentrates on causation of laryngo-hyoid fractures and the potential usefulness of microscopy, particularly identifying evidence of previous trauma.

Causes of laryngeal cartilage and hyoid bone fractures found at postmortem.

The principal aims of this retrospective study were to assess the prevalence and causes of laryngo-hyoid fractures found in coroners' adult postmortem examinations over a five-year period. In 78 of 1930 cases (4%), there was a fracture of the larynx (thyroid or cricoid cartilage) or hyoid bone. The thyroid cartilage alone was fractured in 38 cases; the hyoid bone alone was fractured in 19 cases; the larynx and hyoid bone were both fractured in 21 cases, including one which involved the cricoid cartilage. There was no evidence of surface injury to the neck in 14.1% of cases. The majority (44/78; 56.4%) involved classical manual or ligature 'pressure to the neck', i.e. hanging (32) or strangulation (12) but a significant minority (35.9%) involved other circumstances: road/rail traffic collision (12; 15.4%); falls (6; 7.7%); assaults involving blunt force trauma to the head and neck (4; 5.1%); incised wounds (3; 3.8%); gunshot wounds (2; 2.6%); and explosion (1; 1.3%). The circumstances of death and cause of fracture(s) were 'unascertained' in four cases (5.1%). Postmortem artefact accounted for two cases (2.6%).

Fatal intra-abdominal haemorrhage following percutaneous endoscopic gastrostomy.

An 83-year-old man was admitted to hospital with a general decline in health, including deteriorating ability to swallow. He was not managing sufficient oral intake to meet his daily nutritional requirements, so had a percutaneous endoscopic gastrostomy (PEG) tube inserted for long-term feeding. Following the procedure he became shocked, and was unresponsive to aggressive fluid resuscitation. He died approximately 7 h after the PEG tube insertion. A postmortem examination revealed 2.5 litres of blood and bloodstained fluid within the abdominal cavity and a haemorrhagic pancreas. Microscopy of the pancreas showed a defect in a small to medium-sized artery, likely to be a branch of the splenic artery. The cause of death (as per section 1 of the death certificate) was (1a) intra-abdominal haemorrhage, (1b) pancreatic trauma at PEG feeding tube insertion and (1c) dysphagia due to cerebrovascular disease.

Small bowel perforation and fatal peritonitis following a fall in a 21-month-old child.

The authors report a case of fatal peritonitis due to small bowel perforation in a 21-month-old female child. Necropsy excluded natural disease and a thorough Coronial investigation concluded that an accidental fall onto a "doorstop" caused the bowel injury. The investigative findings are presented; the discussion address issues of diagnosis and causation/mechanism of injury.