A rare case of suicide by bleach fatal ingestion: a case report and a literature overview.

Background: Nowadays it is estimated that worldwide more than 700 000 people die by suicide every year and a greater amount attempt this practice. Suicide is the fourth cause of death among 15-29 years old people. Sodium Hypochlorite (NaOCl) is used in household and com-mercial bleaches and due to its easy availability, accidental exposure to or intentional ingestion of NaOCl occurs frequently. In most cases health effects are only transient but if the subject ingests a large amount of this substance, this can generate severe consequences as oesophageal or stomach lesions and electrolytic imbalance. In the present study we analyse a rare case of suicide by fatal ingestion of bleach. Case Report: Case of a caucasic 47 years old woman with a background of several suicide attempts by exogenous substance ingestion that was found death alone in her apartment. The purpose of our investigation was identifying the cause of death. A rigorous and multidisciplinary methodological approach was adopted, including an accurate judicial inspection of the environment, an anamnestic collection, an autoptic procedure completed by macro and microscopic examinations of internal organs and a toxicological examination of biological fluids. Furthermore, a literature overview of similar cases was carried out. The resulting evidence demonstrates that woman's death occurred after a massive bleach ingestion. Conclusions: This case report highlights the importance of forensic methodology in investigating the ingestion of exogenous substances. Crime scene investigation, a detailed post-mortem examination, toxicology and a complete histopathological study are mandatory to solve the enigma.

Atrial arrhythmias and acute pericarditis triggered by bleach ingestion-associated oesophageal perforation: a case report.

Background: Acute pericarditis due to oesophageal perforation and caustic injury is a rare presentation of bleach ingestion. Cardiac arrhythmias such as atrial fibrillation and atrial flutter have been associated with certain aetiologies of acute pericarditis. This case report presents a unique occurrence of acute pericarditis following bleach ingestion and intermittent atrial fibrillation and atrial flutter triggered by liquid intake. Case summary: A 36-year-old male with no significant past medical history presented after attempted suicide by ingesting bleach. He had acute pericarditis resulting from caustic oesophageal perforation and extensive mediastinal injury. In the following days, he developed recurrent episodes of atrial fibrillation and atrial flutter following fluid intake, prompting treatment with metoprolol. On Day 5 of hospitalization, he underwent an oesophagogram and developed persistent atrial arrhythmia with haemodynamic instability requiring cardioversion. He underwent thoracoscopic surgery to address the oesophageal injury. A jejunostomy tube was placed and he had complete resolution of his recurrent atrial arrhythmia. Discussion: This case highlights a rare presentation of atrial arrhythmias and acute pericarditis caused by corrosive oesophageal injury due to bleach ingestion. The effective management of such cases necessitates a co-ordinated approach, involving the collaboration of cardiothoracic surgeons, cardiologists, and critical care specialists, with the aim of enhancing patient outcomes and mitigating the life-threatening risks associated with oesophageal perforation and cardiac arrhythmias. Furthermore, this case underscores the imperative for further research to better understand the relationship between traumatic acute pericarditis and atrial arrhythmias, offering the potential for improved patient care in these intricate clinical scenarios.

Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon.

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.