Fatal Splenic Rupture Following Heimlich Maneuver Case Report and Literature Review

The most effective resuscitative procedure in choking by foreign bodies is the Heimlich maneuver, described for the first time by Henry Heimlich (1974) and recognized by the US Surgeon General (1985) as the "only method that should be used for the treatment of choking from foreign body airway obstruction.'' If performed correctly, this lifesaving maneuver is associated with rare complications, of which the most frequent are rib fractures and gastric or esophagus perforations. Other rare traumatic injuries such as pneumomediastinum, aortic valve cusp rupture, diaphragmatic herniation, jejunum perforation, hepatic rupture, or mesenteric laceration have been described. However, we are unaware of previous reports of splenic rupture after Heimlich maneuver. We present an interesting case of fatal hemoperitoneum due to a hilar laceration of the spleen following a correctly performed Heimlich maneuver

Role of Preoperative 3-Dimensional Computed Tomography Reconstruction in Depressed Skull Fractures Treated With Craniectomy A Case Report of Forensic Interest

Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production. We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm

Fatal Drowning Accident and Undiagnosed Hydrocephalus

Bodies found in water present several diagnostic challenges for the forensic examiner, such as the identification of the time and mechanism of death, the postmortem submersion time, and above all the circumstances of drowning. We report the case of a 33-year-old security guard found dead in Venice, in the water of the lagoon, who at autopsy presented a previously undiagnosed hydrocephalus with macrocephaly. The victim remained asymptomatic until 2 months before death and had never undergone a neurological or radiological examination. In the article, we emphasize the need to perform a thorough autopsy in all suspected drownings, discuss the etiopathogenesis of the neurological disease and hypothesize a possible relationship between the hydrocephalus and the drowning accident. Finally, we discuss the major clinical and forensic implications of macrocephaly and hydrocephalus in adults

Multifocal Hepatoblastoma: Is There a Place for Partial Hepatectomy? Proceedings of the Tumor Board of the Hematology–Oncology Division of the Department of Pediatrics, University of Padua, Padua, Italy

Today we will address the treatment of a child affected by a multifocal hepatoblastoma (HB). His tumors have shrunk significantly at the end of an 85-day course of preoperative chemotherapy, but still do not seem to be easily resectable. The patient is a 6-year-old boy admitted to the Pediatric Surgical Unit because of an abdominal mass discovered incidentally during a routine medical checkup almost 4 months ago. His family and past medical history were unremarkable. On admission, the physical examination confirmed the presence of a right abdominal mass, and an ultrasound (US) and computed tomography (CT scan) were obtained. At presentation, the serum a-fetoprotein was 380,000 ng/ml with a normal platelet count. Before proceeding, may I ask you please, Dr. Toffolutti, to describe the imaging findings