The Obturation asphyxia: closing of the respiratory tract with food and bulk materials | Forensic Medicine
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Obturation Asphyxia

Closure of the respiratory tract by food masses
Closure of the respiratory tract by food can be observed in people who are severely intoxicated, during general anesthesia, with vomiting or regurgitation , with a craniocerebral trauma accompanied by loss of consciousness and vomiting; with artificial respiration, when pressure is exerted on the area of ​​the chest and abdomen, in infants and children of early childhood when vomiting and regurgitation.

In all these cases, food masses from the stomach move into the esophagus and the oral cavity, which makes it possible, especially when the swallowing act is violated, to aspirate into the upper respiratory tract.

It should be borne in mind that in itself the detection of food masses in the upper parts of the respiratory tract of the corpse does not yet indicate that death has come from asphyxiation, because the food masses can enter the respiratory tract in the agonal period or even after death. Posthumous penetration of food masses into the respiratory tract occurs when the corpse rots, when a significant amount of putrefactive gases is formed. The latter pressure on the stomach, causing the movement of its contents along the esophagus into the oral cavity with further passive flowing into the respiratory tract. Therefore it is necessary to establish; in vivo or posthumously, food masses entered the respiratory tract. The lifetime ingress of food masses into the respiratory tract is evidenced by their penetration not only into the trachea and large bronchi, but also into minute and minute bronchi and even into the alveoli of the lungs. Macroscopically lungs are swollen (acute swelling of the lungs), from the surface of the tuberosity, on the incisions when pressed from the small bronchi and alveoli, particles of food masses are squeezed out. Histological examination in alveoli and bronchioles, small bronchi reveals plant cells, starch grains and other microscopic components of food masses.

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With regurgitation, aspiration of gastric juice is possible, which causes an asthmatic state and pulmonary edema (Mendelssohn syndrome). Phenomena develop rapidly and can cause death or complications in the form of necrotic pneumonia.

With postmortem ingested food masses in the respiratory tract, they penetrate only into the larynx, trachea and large bronchi.

It is necessary to take into account the circumstances of the onset of death, as well as the data of medical documents, if the victim was provided with medical assistance.

Closure of the airways with bulk substances .

Leading to blockage of the airways, asphyxiation and death can aspiration of loose or powdered bodies: cement, sand, cereals, etc. In these cases, the solids will be detected in the upper respiratory tract as they penetrate them as deeply as possible allow the particle size of solids and the caliber of the airways. Develops a typical asphyxia from the closure of the respiratory tract. In the internal investigation of a corpse, loose bodies are found in the oral cavity, in the respiratory tract (where they enter the phase of inspiratory dyspnea, clogging the respiratory tract and, if their diameter allows, penetrate even into the alveoli, which can be confirmed by histological examination). In the process of aspiration, some part of loose bodies can be swallowed, falling into the esophagus and stomach. Loose bodies are found on clothing, open body surfaces. The diagnosis of this kind of asphyxia is simple. The data of the primary examination of the corpse at the place of its detection and the circumstances of death must be taken into account.

Control questions
1. What are the types of asphyxiation from closing the respiratory tract.
2. What is the genesis of death from closing the respiratory tract with soft objects? What are the morphological signs at this type of death?
3. What is the genesis of death when closing the respiratory tract by food masses, loose bodies? What are the morphological signs at this type of death?
4. What is the basis for differential diagnosis of intravital and postmortem ingested food masses in the respiratory tract?