Gastric Contents in Respiratory Tract A Diagnostic Dilemma at Autopsy

Gastric contents in the respiratory tract are commonly found at postmortem in acute alcoholism, occasionally during a fit of epilepsy and in dead bodies that have started decomposing. Quite infrequently it may be found in fresh bodies that have undergone sudden unexpected and unattended death leading to a dilemma as to the real cause of death with dearth of any other substantial evidence. Dead body of a 36-year-old lady was brought for postmortem examination with history of unattended and unexpected death while taking bath after her afternoon meal. On gross and histopathological examination, there was no significant finding in the cardiovascular system but respiratory tract contained gastric contents with histopathology confirming vegetable matter in the terminal bronchioles. The conflicting literature on the difference between antemortem aspiration and postmortem spill of gastric contents into the respiratory tract led to a dilemma as to the real cause of death in present case. Dilemmas of the case with difficulties in diagnosis are being presented herewith.