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Pseudo-Stab Wounds: Putrefactive Dehiscence of Remote Surgical Incisions Masquerading as Stab Wounds

NCJ Number
Journal of Forensic Sciences Volume: 54 Issue: 5 Dated: September 2009 Pages: 1152-1154
James R. Gill, M.D.; Dennis P. Cavalli, RPA-C, M.P.H.; Susan F. Ely, M.D., M.P.H.T.M.
Date Published
September 2009
3 pages
This paper describes a case in which a man found dead in his apartment with advanced decomposition was initially viewed as a homicide due to apparent stab wounds of the torso and the large amount of blood around and distant from the body.
The autopsy, however, failed to find any vital injury. The decedent's history of colon cancer and the locations of the injuries resulted in further investigation that revealed prior surgery. After discussion with the surgeon and a review of the decedent's medical records, the four skin injuries of the torso were determined to be remote surgical incisions (portacatheter placement and laparoscopic-assisted sigmoid resection). The surgery occurred approximately 11 months before death. Although these incisions should have completely healed since the surgery, a relative weakness in these locations allowed the expanding decomposition gases to cause the splitting open of the surgical incisions after death. Postmortem seepage from the opened surgical incisions was supported by the virtual absence of body cavity fluid at autopsy. Moreover, the blood found more distant from the body at the scene was contiguous with that found around the body. The traveling of the fluid was explained by a slight slope of the floor away from the body. The cause of death was determined to be acute opiate intoxication. Toxicological analysis of the brain detected morphine (0.30 mg/kg), benzoylecgonine (0.71 mg/kg), and ethanol (0.13 gm percent). The decedent had never been prescribed morphine for the treatment of cancer-related pain (his cancer was clinically in remission). 2 figures and 11 references


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