doi:10.1016/j.jflm.2008.01.008
Copyright © 2008 Elsevier Ltd and FFLM All rights reserved.
Case Report
Accidental fatal asphyxiation by sand inhalation
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F.A. Benomran MB ChB, DCH
, a,
, Professor of Forensic Medicine and A.I. Hassan MB ChB, MSca, Forensic Medical Examiner
aForensic Medicine Department, General Department of Forensic Science, Dubai Police General Headquarters, P.O. Box 39844, Dubai, United Arab Emirates
Received 25 November 2007;
accepted 26 January 2008.
Available online 10 April 2008.
Abstract
A 36 year old laborer was pronounced dead by the casualty doctor on arrival to the hospital. To avoid blame, witnesses and fellow workers fabricated a scenario that resulted in the doctor certify death as due to myocardial infarction. The body was then taken to the mortuary of the Department of Forensic Medicine as a routine procedure to furnish a medico-legal report, which is a pre-requisite for bodies to be taken out of the country. No external injuries were found by the authors who noted deposition of sand all over the clothed body of the deceased. Some sand was also seen inside eyes, mouth and external ear canals. X-ray examination showed radio-opacities in pharynx, larynx, trachea, bronchi and esophagus. The forensic medical examiners (authors) requested permission for autopsy from the director of public prosecution. Autopsy demonstrated that death was due to asphyxiation due to inhalation and swallowing of sand. Consequent on the opinion of the forensic medical examiners the police opened an inquiry. It was established that the deceased was accidentally buried alive when a wheeled loading shovel emptied its load of sand over him at a construction site. The initial misdiagnosis was attributed to failure of the hospital doctor to realize the significance of the presence of sand in exposed orifices. The false account of the circumstances of death had also contributed to that misdiagnosis.
Keywords: Accidental asphyxiation; Industrial accidents; Suffocation; Sand inhalation
Fig. 1. Sand deposition on the clothing and exposed parts of the deceased’s body.
Fig. 2. Sand in the eyes, mouth and nostrils of the deceased.
Fig. 3. The left ear of the deceased showing sand deposition.
Fig. 4. Chest and abdomen showing sand deposition on chest and in the umbilicus.
Fig. 5. Sand on the right arm, right armpit and chest.
Fig. 6. Chest X-ray showing radio-opacities along the area of the esophagus and air passages.
Fig. 7. Lateral view of the head and neck showing radio-opacities along the pharynx and larynx, upper trachea and esophagus (teeth show removable dentures).
Fig. 8. Autopsy view of the slit-opened pharynx and esophagus to demonstrate extensive sand deposition.
Fig. 9. Autopsy view of the slit-opened trachea and bronchi showing sand deposition.
Fig. 10. The inside of the stomach with sandy material mixed with a minimal quantity of digested food.
Fig. 11. The cut surface of the lung showing marked congestion and edema with frothy exudates as well as sand particles expressed from the small bronchioles.
Fig. 12. Frothy edematous fluid mixed with sand inside the bronchi and the bronchioles.

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