Content area
Full text
Background
Discolouration of the gastrointestinal mucosa at autopsy gives a clue to the forensic pathologist to predict the nature of the substance, poison or drugs ingested by the deceased. Drug abuse is one of the common causes of death in India. Dextropropoxyphene and its various combinations are widely abused drugs in the north-eastern region of India and predominantly affects younger population. 1 Bluish stomach content or mucosal staining, usually gives a clue at autopsy towards the ingestion of copper sulfate or other common food colourants. This patient's case is being presented owing to the rarity of autopsy finding in drug poisoning and described for the first time in the case of this substance abuse.
Case presentation
A 30-year-old woman was brought dead to the emergency medicine department with a history of ingestion of multiple unknown tablets. On the fateful day, she was apparently alright at the morning and was found in an unconscious state by her neighbours at her residence around 18:00 h. She had a history of abdominal pain during her first pregnancy 10 years ago and the same persisted in the postpartum period. She was prescribed 'spasmocip plus' containing acetaminophen (400 mg), dextropropoxyphene (65 mg) and dicyclomine hydrochloride (10 mg) for the same. In course of time she became addicted to the medication owing to dextropropoxyphene and continued to consume the drug without physician's advice. According to the family members, she was depressed owing to this chronic illness. The investigating officer had recovered 30 empty blister packets of spasmocip plus from the crime scene.
Investigations
The body was that of a 30-year-old woman, moderate built of 4.9 ft height, in a state of rigor mortis all over the body. Postmortem lividity of bluish-purple hue was present over the back and dependent parts of the body. Bluish discoloration of nails was present. Multiple linear scar marks, parallel to each other, were seen over the ventral aspect of left forearm. No other fresh external antemortem injury was seen. Upon internal examination both the lungs were found to be congested. Stomach contained about 500 ml of blue colour indistinguishable liquid and gastric mucosa was bluish stained ( figure 1 A,B). The...