Time-related injuries represent a challenge for forensic medicine due to the difficulty to date them.
We report the case of a 45-year-old man with a history of drug addiction who was found dead at home.
External examination revealed asthenic constitutional habit, beginning of green spot at the level of both iliac fossas, punctiform excoriations in the right frontoparietal region, right upper limb with superficial excoriation in the right hand.
The injuries described were compatible with an aggression that had suffered three days before, according to the witnesses' reference.
In principle, the officials of the authority did not take into account this complaint of witnesses being framed in the world of polytoxicomania and directing themselves to citizens without antecedents that would have been taken into consideration when intervening.
The clinical picture raises, among others, the following hypotheses: either it is a sudden death or we are faced with a described adverse drug reaction or it must be considered that it can be a traumatic death.
After performing the autopsy, unexpectedly, it is established as a conclusion a two-step rupture of the spleen that is later confirmed by histopathology and derived in a murder procedure, which had gone unnoticed.
Internal examination revealed the following findings:
- cranial cavity: hemorrhagic infiltrates in the right retroauricular region and in the right temporal region.
Absence of traumatic bone lesions, meningeal and skeletal malformations.
- left rib cage: the lateral and posterior portion of the 8th and 9th ribs of the lower left lung with extensive haemorrhagic origin in the intercostal muscles and a haemorrhagic area
- Abdominal cavity: massive hemoperitoneum of 2.360 cm3, at the splenic flexure level in soft parts, face bleeding in upper pole of 400 g, external face level rupture.
Cyrotic liver.
Anemic paleness of abdominal organs, mainly the liver and kidneys
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- right hand: non-hepatomatic in the interosseous muscles.
- The anatomopathological report showed micronodular cirrhosis; a large pulmonary fragment of the left lower lobe together with abundant fluid of edema and numerous macrophages of large-scalenecrophage; a large capsule of hemorrhage was observed as an irregular area.
Several foci of hemorrhagic aspect are found on the cutting surface.
associated with a massive bleeding and a massive bleeding located around the haematoma.
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- The toxicological study showed a concentration:
- 0.41 g/l of ethanol in the blood.
High doses of cocaine
- 0,81 mg/l of methylecgonine in blood.
- 7.31 mg/l benzoylecgonine in the blood.
Acquirement of medication
