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Esophageal foreign bodies as child abuse. Potential fatal mechanisms
1Office of the Medical Investigator, University of New Mexico, School of Medicine, School of Medicine, Albuquerque 87131-5091.
Insights
Fatal child abuse involving esophageal foreign bodies, like coins, is rare. Autopsy revealed coins, fractures, and contusions, indicating severe abuse and multiple potential causes of death in an infant.
Area of Science:
- Forensic Pathology
- Pediatric Medicine
- Child Abuse Research
Background:
- Foreign body ingestion is a common pediatric emergency, but esophageal impaction as a form of fatal child abuse is exceptionally rare.
- This case highlights a severe form of non-accidental trauma in an infant.
Observation:
- A 4.5-month-old infant presented with respiratory distress and coins were found in the esophagus.
- Post-mortem examination revealed coins in the esophagus, cutaneous contusions, fractures, aspirated foreign material, and pulmonary fat emboli.
Findings:
- Multiple esophageal coins were identified as a potential cause of death.
- Other contributing factors included vagal stimulation, aspiration, airway compression, and cardiac compression by the foreign bodies or the abuser's finger.
Implications:
- This case underscores the importance of considering child abuse in infants presenting with unusual foreign body ingestions.
- Forensic pathologists and clinicians must be aware of the diverse and potentially fatal mechanisms associated with esophageal foreign bodies in abusive scenarios.
- Early recognition and intervention are critical to prevent fatal outcomes in suspected child abuse cases.
Abstract:
Foreign bodies being forced into the esophagus as a form of fatal child abuse is rare. A 4.5-month-old female infant presented to clinicians with respiratory distress. Several coins were recovered from the esophagus. One month later, she was found dead in her crib. At autopsy, there were three coins in the esophagus. In addition, there were cutaneous contusions of various ages, acute and partially healed fractures of the extremities, old aspirated foreign material in the lungs, and pulmonary fat emboli. Although the fat emboli may have contributed to the death, several potentially fatal mechanisms from the esophageal foreign bodies deserve consideration. These include vagal stimulation from esophageal distention, aspiration of swallowed fluids after esophageal obstruction, compression of the trachea or the heart by the coins, and cardiac compression or airway occlusion by the introducing finger.