Forensic science, medicine, and pathology
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Bullet retrieval from the body of a gunshot victim is one of many tasks in post-mortem forensic examination. Rarely, it is complicated by the migration of the missile away from the entry point by vessel embolism. ⋯ A missile had moved within the colon during hospitalization and postmortem handling of the body and was recovered from the sigmoid colon. This case demonstrates an extremely rare type of bullet "embolism" and emphasizes the usefulness of CT scanning in the location of projectiles.
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Forensic Sci Med Pathol · Jun 2010
Case ReportsAn unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report.
Ruptured aortic aneurysms often present with sudden death, and have varied signs and symptoms depending on the site of rupture and hemorrhage. We report a case of an aortic aneurysm with an aorto-esophageal fistula, which showed slow gastrointestinal bleeding for days before death. A 79-year-old male was brought to a hospital emergency unit, with a history of melena for about 3 days, and recent hematemesis. ⋯ A forensic autopsy which was performed due to possible medical malpractice demonstrated a large saccular aneurysm of the descending thoracic aorta with a fistula into the esophagus. A significant finding was a lid or valve shaped thrombus covering the aortic orifice of the fistula, which may have partly contributed to slow bleeding, and which may have been dislodged by endoscopy. This case suggests that very careful management of aorto-esophageal fistula is needed in patients with clinical signs of possible thoracic aortic aneurysm with slow hemorrhage.
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Stabbing, mechanical asphyxia, blunt head injury and shooting are the most common methods of homicides, with firearm homicides on the increase throughout the world. This study was a retrospective study carried out by the Department of Forensic Medicine, University of Kelaniya, Sri Lanka over a 1 year period on firearm homicides examined at two principal forensic institutions in the western province (Office of the Judicial Medical Officer Colombo and Ragama) of Sri Lanka. During the period of the study (June 2005 to July 2006) 3100 medicolegal autopsies were carried out at these two institutions with 265 representing alleged homicides. ⋯ The weapon of choice was a rifled firearm (98%). While 70% of war-related deaths had one or two fatal shots, either to the head or chest, homicides motivated by personal enmity had multiple wounds, with an average of 5.7 fatal shots per victim. This study demonstrates that firearm homicides in Sri Lanka mainly involve young men, and that when related to armed conflict the fatal injury usually consists of a single shot to the head or chest.
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The location of an entrance wound (bullet placement) and the projectile path are the most important factors in causing significant injury or death following a shooting. The head followed by the torso are the most vulnerable areas, with incapacitation resulting from central nervous system (brain or cord) disruption, or massive organ destruction with hemorrhage. Tissue and organ trauma result from the permanent wound cavity caused by direct destruction by the bullet, and also from radial stretching of surrounding tissues causing a temporary wound cavity. ⋯ The latter includes resistance to strain, physical dimensions of an organ, and the presence or absence of surrounding anatomical constraints. Bullet shape and construction will also affect tissue damage and bullets which display greater yaw will be associated with increased temporary cavitation. Military bullet designs do not include bullets that will expand or flatten as these cause greater wound trauma and are regulated by convention.
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Forensic Sci Med Pathol · Jan 2009
Review Case ReportsIntersecting fractures of the skull and gunshot wounds. Case report and literature review.
When two fracture lines of a solid surface (ice, glass, eggshell, etc.) intersect, it is always possible to tell which one has been made first. Indeed pre-existing damage of the surface arrests all the fracture lines produced by subsequent impacts. ⋯ It can help sequencing blunt force or gunshot injuries determining the direction of fire and differentiating entrance from exit wounds in the absence of specific distinguishing features (i.e., internal/external beveling of the skull or overlying skin indicators). In this context, we report the case of a 76-year-old man who shot himself in the mouth with a Walther PPK 7.65 handgun and highlight the utility of the application of both Puppe's Rule and Multislice Computed Tomography (MSCT) in the examination of gunshot wounds to the skull.