Source (ResearchGate)

Fig 1: Brownish black staining on angle of mouth and front of neck.
Fig 2: Corrosion and perforation of stomach.
Fig 3: Blackened, friable upper GI tract with peritonitis

A 17 year old boy deliberately ingested sulphuric acid and was admitted in the hospital for treatment. The patient was in excruciating pain, had blood vomiting with cold clammy skin, sweating, blood pressure 80/50 mmHg, pulse 160/min and respiration rate 60/min. He was in a state of shock. There was rigidity and tenderness on palpation of abdomen. Ryle’s tube intubation was done and the toxic collection was aspirated. Humidified oxygen was administered. IV fluids, blood transfusion and antibiotics were also given as required. Endoscopy and surgery were planned to be done after the patient’s condition became stable. But he died within a day of the incident before doing any surgery. The deceased was sent for medicolegal autopsy. On autopsy it was found that he had some brownish black acid stains over the lips. Brownish black dribbling marks were found from the right angle of the mouth to front of the neck (Figure 1). Some brownish black stains were also seen around the nostrils. The conjunctiva was congested and nail bed was cyanosed. The oral cavity and the tongue revealed some blackish stains. On dissection, the mucosa of oesophagus was blackened and congested with some white semisolid substance in the lumen. There was extensive corrosion, blackening, disorganisation and perforation of the stomach (Figure 2). The perforation was massive, irregular, blackened and situated along its posterior aspect close to the cardiac end. Some acid digested blood was adhering to the gastric mucosa. The soft tissue surrounding it was fragile and the tear extended during dissection. There was spilling of the gastric contents and bile into the peritoneal cavity with peritonitis (Figure 3). The surface of the liver looked greenish black. All other internal organs were intact and congested. The stomach, a loop of intestine, 500gms of liver and half of each kidney were preserved in rectified spirit and sent for toxicological analysis. The chemical examiners report was positive for sulphuric acid in the viscera.