Death by bolus impaction of the larynx

The paper reports on 78 cases of fatal choking observed in the Institute of Legal Medicine, University of Duesseldorf, since 1947. The age median of all victims was 53 years. There were 24 females among the victims. Only in one child a solitary occlusion of the glottis by a collar-button was found. In all other cases bolus material was distributed over more than one region, e.g. larynx, glottis and trachea. In 50 victims single pieces of meat, ham, herring etc. were found. In the remaining 28 cases the bolus material was roughly chewed. More than 80 per cent of cases occurred in restaurants and lodgings, only small numbers in public places, shops and hospitals. With the exception of three children, one patient with a partial horizontal resection of the larynx and some mentally handicapped persons all bolus death victims were heavily drunk (median BAC 2.1 Promille). The possible pathomechanisms were discussed.