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Layering of stomach contents in drowning cases in post-mortem computed tomography compared to forensic autopsy

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International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Background

In forensic autopsy, the analysis of stomach contents is important when investigating drowning cases. Three-layering of stomach contents may be interpreted as a diagnostic hint to drowning due to swallowing of larger amounts of water or other drowning media. The authors experienced frequent discrepancies of numbers of stomach content layering in drowning cases between post-mortem computed tomography (PMCT) and autopsy in forensic casework. Therefore, the goal of this study was to compare layering of stomach contents in drowning cases between PMCT and forensic autopsy.

Methods

Drowning cases (n = 55; 40 male, 15 female, mean age 45.3 years; mean amount of stomach content 223 ml) that received PMCT prior to forensic autopsy were retrospectively analyzed by a forensic pathologist and a radiologist. Number of layers of stomach content in PMCT were compared to number of layers at forensic autopsy.

Results

In 28 of the 55 evaluated drowning cases, a discrepancy between layering of stomach contents at autopsy compared to PMCT was observed: 1 layer at autopsy (n = 28): 50% discrepancy to PMCT, 2 layers (n = 20): 45% discrepancy, and 3 layers (n = 7): 71.4% discrepancy. Sensitivity of correctly determining layering (as observed at forensic autopsy) in PMCT was 52% (positive predictive value 44.8%). Specificity was 46.6% (negative predictive value 53.8%). In a control group (n = 35) of non-drowning cases, three-layering of stomach contents was not observed.

Conclusion

Discrepancies of observed numbers of stomach content layers between PMCT and forensic autopsy are a frequent finding possibly due to stomach content sampling technique at autopsy and movement of the corpse prior to PMCT and autopsy. Three-layering in PMCT, if indeed present, may be interpreted as a hint to drowning.

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Abbreviations

FN:

False negative

FP:

False positive

HU:

Hounsfield unit

kV:

Kilovolt

ms:

Milliseconds

NPV:

Negative predictive value

PMCT:

Post-mortem computed tomography

PMI:

Post-mortem interval

PPV:

Positive predictive value

TN:

True negative

TP:

True positive

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Acknowledgements

We would like to express our gratitude to our team of forensic pathologists and forensic technicians for their support with case handling.

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Authors and Affiliations

  1. Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland

    Walther Gotsmy, Paolo Lombardo, Christian Jackowski, Eva Brencicova & Wolf-Dieter Zech

  2. Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, CH-3010, Bern, Switzerland

    Paolo Lombardo

Authors
  1. Walther Gotsmy
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  2. Paolo Lombardo
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  3. Christian Jackowski
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  4. Eva Brencicova
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  5. Wolf-Dieter Zech
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Correspondence to Wolf-Dieter Zech.

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Gotsmy, W., Lombardo, P., Jackowski, C. et al. Layering of stomach contents in drowning cases in post-mortem computed tomography compared to forensic autopsy. Int J Legal Med 133, 181–188 (2019). https://doi.org/10.1007/s00414-018-1850-4

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  • DOI: https://doi.org/10.1007/s00414-018-1850-4

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