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CASE REPORT
Year : 2018  |  Volume : 32  |  Issue : 1  |  Page : 69-71

A case of choking presenting as death due to police torture


Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication18-Jun-2018

Correspondence Address:
Dr. Meera Thounaojam
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_30_17

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  Abstract 

Choking is the obstruction of the flow of air into the lungs and is almost always accidental. In this paper, a case of choking mistaken as death due to police torture is reported. A man was brought by the police to a hospital in Imphal, and the person expired on reaching there. Family members alleged that the police had a hand in the victim's death and that he died due to their torture. A meticulous autopsy helped in establishing the exact cause of death in this case thereby disproving the false charge of assault.

Keywords: Allegation, choking, police torture


How to cite this article:
Phanjoubam M, Thounaojam M, Thongam D. A case of choking presenting as death due to police torture. J Med Soc 2018;32:69-71

How to cite this URL:
Phanjoubam M, Thounaojam M, Thongam D. A case of choking presenting as death due to police torture. J Med Soc [serial online] 2018 [cited 2020 May 25];32:69-71. Available from: http://www.jmedsoc.org/text.asp?2018/32/1/69/213951


  Introduction Top


Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal. Choking can be caused by (i) physical obstruction of the airway by a foreign body, (ii) respiratory diseases that involve obstruction of the airway, and (iii) compression of the laryngopharynx, larynx, or trachea in strangulation and (intravenous) laryngospasm.[1] Obstruction of the airway can occur at the level of the pharynx or trachea. Food that can adapt their shape to that of the pharynx (such as bananas and gelatinous candies) can be a danger not just for children but for persons of any age.[2] Among some of the most notable cases of choking deaths, mention may be made of Air Marshal Subroto Mukerjee, the first Chief of the Air Staff of the Indian Air Force, died on November 08, 1960, at Tokyo, by choking on a piece of food lodged in his windpipe.[3]

On the other hand, allegations of excessive use of force and extrajudicial killings by police or armed forces are common in the northeastern state of Manipur. A petition filed by two nongovernmental organizations with the Supreme Court of India claimed that at least 1528 extrajudicial killings were carried out by the police or security forces in Manipur during 1979–2012 (Supreme Court of India Writ Petition [Criminal] No. 129 of 2012).[4] Interestingly, the present case was also brought as a case of death due to police atrocity which was disproved by autopsy as it turned out to be due to choking and a case of natural death.


  Case Report Top


According to the history given by the police, in the late hours of one November night in 2014, a 32-year-old man was found in an unconscious state near a food joint in Imphal. The police personnel on duty in that area took him to a nearby hospital where he was declared “brought dead.” Family members alleged that the man was beaten to death by the police. Postmortem examination was done 2 days after the death of the person. On postmortem examination, there were only two small abrasions, red in color, one on the right side of the face (1 cm × 0.6 cm) and the other on the back of the left hand (2.2 cm × 1.5 cm). Internally, semidigested food particles consisting of rice and vegetable matter clogged the respiratory tract up to the terminal bronchioles [Figure 1], [Figure 2], [Figure 3]. The heart was filled with dark fluid blood. The lungs were congested and edematous [Figure 4] and the other viscera were congested. Sections taken from both the lungs for histopathology showed areas of marked congestion, edema and hyperinflation, and mild inflammatory reactions around the foci of food matter in the bronchioles and alveoli. The cause of death was asphyxia resulting from choking with food particles.
Figure 1: Vegetable pieces in the airway

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Figure 2: Bolus of rice particles mixed with vegetables clogging the bronchi

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Figure 3: Food particles in bronchioles

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Figure 4: Congested and edematous lungs

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  Discussion Top


Airway obstruction can be of anatomical or mechanical origin. Anatomical obstruction may be produced by anatomical structures such as tongue, swollen tissues of mouth and throat like inflamed epiglottis. Mechanical obstruction occurs due to foreign body.[5] Physical findings of wheeze, rhonchi, stridor, or retractions were associated significantly with a diagnosis of an unwitnessed foreign body.[6] Death due to choking is due to unintentional ingestion or inhalation of food or other objects resulting in the obstruction of respiration.[7] In natural deaths due to choking, there is obstruction of the airway by the inflamed epiglottis and adjacent soft tissue and are of anatomical origin as said above. Choking is almost always accidental. In the present case, the death which was suspected to be a homicide turned out to be an accidental death due to mechanical airway obstruction by food particles.

Some of the common risk factors of choking are old age, poor dentition and alcohol consumption. Other risk factors include chronic disease, sedation, and eating risky food.[7],[8] In the present case, there was no finding of alcohol or any other drug. Some of the other common causes of choking include swallowing large pieces of poorly chewed food, eating while talking excitedly or laughing, or eating too fast and walking, playing, or running with food or object in the mouth.[5] Hence, one of these factors could have caused the choking in this case.

On the other hand, gastric contents are aspirated in the windpipe due to the handling of the body, as a terminal event in natural death (agonal artefact) or due to resuscitation. Hence, agonal artefact may look like a case of choking and vice versa. However, the difference lies in the extent up to which food particles enter the lungs. In choking, the bronchioles are filled with food particles whereas in agonal artefact, food particles may reach only up to the larynx.[9] Even though the allegation was that of death due to police torture, the points in favor of choking in this case were the absence of signs of external or internal physical injury, the presence of food particles in the respiratory tract reaching up to the bronchioles (which ruled out agonal artefact), and the presence of signs of asphyxia.


  Conclusion Top


Any complaint is not true unless it is proved so. A meticulous autopsy helped in establishing the exact cause of death in this case by disproving the false charge of assault thereby avoiding public outrage. From the legal standpoint, the importance of establishing an exact diagnosis is obvious. whenever death is attributed to heart disease, the beneficiary of the estate is denied the double indemnity insurance benefits that are allotted when death can be proved to have occurred as the result of accidental inhalation of food.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Choking. Available from: https://www.revolvy.com/main/index.php?s=Choking&item_ type=topic. [Last accessed on 2017 Jan 20].  Back to cited text no. 1
    
2.
Sayadi R. Swallow Safely: How Swallowing Problems Threaten the Elderly and Others. 1st ed. Natick, MA: Inside/Outside Press; 2010. p. 46-7.  Back to cited text no. 2
    
3.
The Saga of a Soaring Legend. IAF. Available from: http://www.indianairforce.nic.in. [Last accessed on 2017 Jan 18].  Back to cited text no. 3
    
4.
Available from: http://www.supremecourtofindia.nic.in/FileServer/2016-07-08_1467967629.pdf. [Last accessed on 2017 Jan 18].  Back to cited text no. 4
    
5.
Pawar MN, Patil DT, Goodbole HV. Uncommon Choking: A case report. Medico-legal Update 2008;8:3-4.  Back to cited text no. 5
    
6.
Louie JP, Alpern ER, Windreich RM. Witnessed and unwitnessed esophageal foreign bodies in children. Pediatr Emerg Care 2005;21:582-5.  Back to cited text no. 6
[PUBMED]    
7.
Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, Fasching P, Keil W. Foreign body asphyxia: A preventable cause of death in the elderly. Am J Prev Med 2005;28:65-9.  Back to cited text no. 7
    
8.
Dolkas L, Stanley C, Smith AM, Vilke GM. Deaths associated with choking in San Diego county. J Forensic Sci 2007;52:176-9.  Back to cited text no. 8
[PUBMED]    
9.
Subrahmanyam BV. Modi's Medical Jurisprudence and Toxicology. 22nd ed. New Delhi: Butterworths; 1999.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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