Distension

Various gases are produced (e.g., hydrogen sulfide, methane, ammonia, carbon dioxide) during putrefaction. Gaseous permeation into skin/soft tissue and organs manifests as crepitus and distension. Localized swelling of the genitalia, anus, and face (bulging eyes, tongue protrusion) is seen. The deceased is unrecognizable. Generalized body distension

Fig. 23. "Marbling" of right leg in contrast to lividity of left leg. The blood vessels have been accentuated by decomposition.

can suggest an apparently large individual. Gas accumulates in body cavities, and their opening is marked by an audible expulsion and visible deflation of the body.

• Significance o Apparent "epistaxis" caused by rupture of nasal vessels occurs.

° Gaseous distension of lungs leads to expulsion of sanguinous fluid and gastric content from the mouth and nose ("purge"), simulating a facial injury (Fig. 26). Gas can force feces from the rectum. Postmortem expulsion of a fetus has been described (3).

o Postmortem surgical wound dehiscence mimics sharp-force injury. A history of prior surgery and the finding of sutures in the wound solve this problem (58,59). Dehiscence occurs even in wounds that are months old (58).

5.2.3. Degradation

Decomposition causes a loss of anatomic integrity of skin and other tissues. Localized areas of skin peel ("skin slippage") occur (Fig. 27). Gas- or fluid-filled cutaneous blisters form (Fig. 28). Broken blisters and areas of skin slippage dry out, leaving yellow/brown/red

Fig. 24. Decomposed body. Note "congestion" of subarachnoid blood vessels on the posterior aspect of the brain (below level of arrows).

Fig. 25. Pink teeth caused by decomposition. (See Companion CD for color version of this figure.)
Human Decomposition Forensic Pathology
Fig. 26. Decomposition. "Purge" of sanguinous fluid from nostrils and mouth.

areas with a parchment-like texture (Fig. 29). The attachment of hair and nails loosens, allowing for their easy removal. Scalp hair remains as a mass in warm weather (47). Loosening of skin of hands and feet leads to "degloving" (Fig. 30). Apparent ruptures of the upper gastrointestinal tract (esophagus, esophagomalacia; stomach, gastromalacia) are observed. If microscopic examination shows an inflammatory reaction, then the rupture is antemortem. Cystic change in the brain (encephalomalacia) mimics infarcts. • Significance ° Loss of skin integrity mimics trauma (e.g., abrasion). ° Blister formation simulates thermal injury.

° Ocular petechiae can disappear with decomposition, although drying can preserve them (42).

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