Jacob B, Huckenbeck W, Barz J, Bonte W
Institute of Legal Medicine, Heinrich-Heine-University Düsseldorf, West Germany.
Am J Forensic Med Pathol. 1990 Dec;11(4):331-5. doi: 10.1097/00000433-199012000-00014.
A 46-year-old woman who had had a long-term schizoid psychosis collapsed on the street. Upon admission to the hospital, she was determined to have an acute abdomen. The chest radiograph showed metallic foreign bodies in both main bronchi; foreign bodies in the stomach were not observed clinically. The woman died from repeated cardiac arrest shortly after hospital admission. At the autopsy a screw and a nail were found in both main bronchi. The abdominal cavity contained 2 L of greenish purulent fluid and a massive fibrinoid peritonitis was observed. Two perforations of the stomach, each 1 cm in diameter, were detected. The stomach was completely filled with a mass of metallic foreign bodies, greenish fluid, and a bezoar of a total weight of 1,400 g; 422 distinguishable and mostly metallic foreign bodies were counted. Death was attributed to cardiac arrest in delayed shock after massive purulent peritonitis caused by two gastric perforations combined with obstruction of the airways by aspirated foreign bodies. Cases of massive swallowing of foreign bodies are mainly restricted to mentally handicapped persons, especially schizophrenics, whereas acute impaction of the larynx by large food particles occurs nearly exclusively in heavily intoxicated adults.
一名患有长期类精神分裂症精神病的46岁女性在街上晕倒。入院时，她被诊断为急腹症。胸部X光片显示两个主支气管内有金属异物；临床上未观察到胃内有异物。该女性入院后不久因反复心脏骤停死亡。尸检发现两个主支气管内各有一枚螺丝钉和一枚钉子。腹腔内有2升绿色脓性液体，并观察到严重的纤维蛋白性腹膜炎。检测到胃有两个直径各为1厘米的穿孔。胃内完全充满了一团金属异物、绿色液体和一个总计重1400克的胃石；清点出422个可区分的、大多为金属的异物。死亡原因是由两个胃穿孔引起的大量脓性腹膜炎合并吸入性异物导致气道阻塞后发生的迟发性休克中的心脏骤停。大量吞食异物的病例主要局限于智障人士，尤其是精神分裂症患者，而大食物颗粒急性阻塞喉部几乎仅发生在严重醉酒的成年人中。
