Advenier A-S, Dorandeu A, Charlier P, Lorin de la Grandmaison G
Department of Forensic Medicine and Pathology, Versailles-Saint-Quentin University, AP-HP, Raymond Poincaré Hospital, Garches, France.
Department of Forensic Medicine, Lapeyronie Universitary Hospital, Montpellier, France.
Forensic Sci Int. 2014 Jan;234:57-63. doi: 10.1016/j.forsciint.2013.10.039. Epub 2013 Nov 12.
Although lesions related to chemical burns have been studied through case reports, clinical analyses and autopsy series, microscopic lesions have not yet been precisely described. Our study analyses the microscopic lesions recorded after caustic exposure in fourteen lethal and four non-lethal cases. We find that microscopic lesions after caustic exposure are various and non-specific. Moreover, the distribution of gastrointestinal lesions is inconsistent. Histological changes affect the digestive mucosa first, with the entire wall suffering damage in some cases. Multiple factors influence the pattern of lesions, including the nature of the caustic substance, the duration of contact, the amount of the substance encountering the tissue and the length of postingestion survival. The assessment of microscopic lesions, especially necrosis, can be limited by post-mortem autolysis, which quickly affects the digestive tract. Chemical pneumonia due to caustic burns is rare and, when present, typically secondary to aspiration. According to the presented findings, macroscopic examination at autopsy under- or overestimates the nature and degree of lesions. Significant complications of caustic ingestion such as chemical pneumonitis can also be found by histological analysis. Microscopic examination can be useful to rule out oesophagitis or other digestive pathologies that can mimic chemical burns.
尽管通过病例报告、临床分析和尸检系列对与化学烧伤相关的病变进行了研究，但微观病变尚未得到精确描述。我们的研究分析了14例致死病例和4例非致死病例在接触苛性物质后的微观病变。我们发现，接触苛性物质后的微观病变多种多样且不具有特异性。此外，胃肠道病变的分布并不一致。组织学变化首先影响消化黏膜，在某些情况下整个肠壁都会受损。多种因素影响病变模式，包括苛性物质的性质、接触时间、接触组织的物质数量以及摄入后存活时间。微观病变的评估，尤其是坏死情况，可能会受到死后自溶的限制，自溶会迅速影响消化道。苛性烧伤引起的化学性肺炎很少见，一旦出现通常继发于误吸。根据所呈现的研究结果，尸检时的宏观检查会低估或高估病变的性质和程度。通过组织学分析也可以发现苛性物质摄入的严重并发症，如化学性肺炎。微观检查有助于排除可能模仿化学烧伤的食管炎或其他消化系统疾病。
