19.-SUICIDE (PARAQUAT- GRAMOXONE) POISONING: CHROMOPATHOLOGICAL FINDINGS.Prof.Garfia.A

19.-SUICIDE PARAQUAT POISONING (GRAMOXONE): CHROMOPATHOLOGICAL ESOPHAGUS-STOMACH IMPREGNATION USEFUL FOR THE DIFFERENTIAL DIAGNOSIS IN CASES OF POISONING DUE TO INGESTION OF CHEMICALS SUBSTANCES.

Prof. Garfia.A

A woman 58, years old, was admitted to the Hospital in a cardiorespiratory arrest after she had drank a glass 250 ml containing Gramoxone ( 1,1´-dipiridil-4,54´dipirilon). A Legal Autopsy was carried out which demonstrated the existence of corrosive lesions around the mouth; the esophageal mucosa was partially desquamated and the gastric mucosa showed one perforation through the posterior wall of the stomach.The more characteristic autopsy finding was the intense green color of the mucosa and submucosa of the oesophagus and stomach wall ; in the case of the stomach, from the mucosa until the serosa, all the gastric wall was coloured in green due to the exit of the herbicide into the abdominal cavity through the perforation of the gastric wall.The Gramoxone pH measured from 6-8 and the gastric content pH was 1. The macroscopic lesions can not be attributed, exclusively, to the ingestion of Gramoxone. Inside the glass from which the woman had drank was found hydrochloric acid that she had used to dissolve the Gramoxon.The colicuative necrosis of the esophageal and gastric mucosa was attributed to the action of the alkaline hydrochloric acid.

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Fig. 1.- This picture was taken from a bottle of Gramoxone Plus which contains Paraquat and Diquat.Prof.Garfia.A

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Fig. 2.- Showing the aspect and the color of the Gramoxone solution. Prof.Garfia.A

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Fig. 3.- Esophagus.Macroscopical aspect showing the mucous membrane, necrotic and detached from the submucous layer - as sphacelous necrotic sheets.The submucous layer and the vascular submucous plexus can be seen under the necrotic sheet. Prof.Garfia.A

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Fig. 4.- Esophagus. Microscopic section showing the transmural necrosis of the esophagus wall. At the left side is located the mucous membrane; at the right side, the submucous and the muscle layer (coloured in red). Note the difficulty of the tissues to take the dyes-that is very typical when a tisular colicuative necrosis occurs - of the Trichromic Stain. Prof.Garfia.A

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Fig. 5.- Esophagus.-Microscopic section of the wall showing the mucous membrane ( on top of the photo), the submucous glands and the severe dilatation of the vessels, due to the caustic effect of the hydrochloric acid. Prof.Garfia. A

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Fig. 6.1- Stomach. Macroscopical aspect. Note the intense green color of the gastric serosa due to the pass of the Gramoxone through the perforation located in the posterior wall of the stomach.Prof.Garfia.A


Fig.6.2.- The gastric mucosa was focally necrotic and coloured in emerald green. In those areas were the mucous membrane layer was absent we can see the submucous vascular net, due to the severe congestion and dilatation of the small submucous vessels. Prof.Garfia.A

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Fig. 7.-Stomach. Showing the microvascular pattern of the submucous layer. The caustic effect of the hydrochloric acid on the microvessels produced vasodilatation and congestion which, together with the coloured effect of the Gramoxone, showed the microvascular pattern of the submucous layer. Normally that is only possible using silver impregnation technics (see: Garfia.A.-Glomus tissue in the vicinity of the human carotid sinus region.Journal of Anatomy. 132:1-12.1980). 
Prof.Garfia.A