法医学ジャーナル

We report the case of a middle-aged male working on board a ship. His body was found floating in the river, near shoreline, by security officials. A postmortem on the decomposed body revealed a recent myocardial infarction. Comorbid conditions included coronary atheromatous disease and long term tobacco smoking. Not all bodies found dead in water are likely to have drowned. This case demonstrates the importance of a thorough forensic investigation, particularly in histological terms, in subjects found dead in water, in order to ascertain the real cause of death, which may not be always assigned to asphyxia by drowning.

Forensic science is the application of science and technology to the detection and investigation of crime. Forensic science has shaped the world of justice, signifying the examination of crime with the help of modern and advanced technology. In this retrospective study, the viscera sent to toxicology and DNA section of FSL during autopsy at mortuary of Adichunchanagiri Institute of Medical Sciences, Mandya district, Karnataka, India, between January 2013 to December 2017 were analyzed. During this study, several epidemiological observations and their results were considered. Out of 748 autopsied cases, in 256 cases viscera has been forwarded to Toxicology section of forensic science laboratory and in 43 unidentified bodies either femur bone or liver tissue has been forwarded to DNA section. In all the 256 cases viscera has been subjected to toxicological examination at forensic science laboratory, in that 211 cases we received positive results, stating the type and amount of poison present at the time of death. In 43 cases viscera has been forwarded to DNA section, and the report has been forwarded to honorable court. With the rising population combined with inflation and economic downturns, there is an increased spurt of crime rates of all natures in the society. To ensure adequate and timely justice to the victims of offences a proper autopsy coupled with laboratory backing will go a long way in supplementing the work of police investigation in order to convert suspicion into a reasonable certainty of either guilt or innocence.

Introduction
Sudden death due to Gastroinstestinal (GI) causes amount to 10% of all sudden death. Esophageal varices is one of the GI causes of sudden death. It develops as a complication of liver cirrhosis. The prevalence of esohgaeal varices in cirrhosis patients is 50% and mortality rate varies between 20%-35% with male female ratio of 1:9. The one year bleeding rate of small and large varices is 5% and 15%. Mortality rate increases with increased age.
Case-Series
Six case of sudden death were seen in the mortuary of a tertiary hospital. The six cases were males, alcoholics. On autopsy, similar findings of cirrhotic liver and hemorrhagic mucosa of the stomach with bleeding spots on lower one third of esophagus were observed.
Discussion
Collaterals develop with development of portal hypertension. Some sites are pre disposed to rupture like the esophageal varices. Risk factors of variceal rupture are red streaks in lumen of esophagus and deranged liver function tests. On gross examination, signs of deranged liver functions are noted. On internal examination, esophagus is everted attached to the stomach and varices are seen shine to through the mucosa. Liver had cirrhotic changes and spleen was enlarged and congested in all the six cases.
Conclusion
The case series emphasizes the importance of fatal esophageal variceal hemorrhage as an important cause of sudden death occurring outside the hospital in alcohol-addicted individuals, often in isolated scenarios.