On June 5438+1October 65438+September, 2006, Chen Mou was stabbed in the abdomen with a fruit knife, and then underwent abdominal exploration in the local county hospital. He was diagnosed as "mesenteric rupture, the first 1 1 cartilage rupture" and was admitted to hospital for treatment. After one month, the condition worsened, and it was considered as "duodenal fistula". It is recommended to transfer to another hospital. In the same year165438+1October1May, he was transferred to the municipal hospital for abdominal exploration. It was found that there was obvious adhesion in the abdominal cavity, forming an abscess cavity, which was diagnosed as "abdominal knife stab wound and duodenal fistula" After further treatment in this hospital, she became listless and her symptoms became worse on June 65438+February 14. Due to financial difficulties, Chen Mou's family asked him to leave the hospital, and he died six days later. Forensic pathological autopsy report: mild cerebral edema, severe pulmonary edema, right ventricular mural thrombus, coronary artery and active atherosclerosis, mild fatty liver, autolysis of liver, kidney and pancreas, fatty liver, extensive adhesion with surrounding tissues after small intestine rupture and suture, and biliary inflammation. The analysis showed that Chen Mou was stabbed in the right abdomen by a sharp instrument, which led to the rupture of the duodenum and mesentery. After the first exploratory laparotomy, there was no duodenal rupture and duodenal fistula. He died of multiple organ failure due to long-term duodenal fistula complicated with electrolyte disorder, severe abdominal infection and severe malnutrition. No duodenal rupture was found in the first surgical exploration, and improper management of intestinal fistula was the important factors that led to Chen Mou's death. It can be seen from this case that trauma causes duodenal fistula, and trauma is the direct cause; Severe abdominal infection and severe malnutrition can lead to multiple organ failure and death.

Analysis according to law

In forensic identification of injury cases, sometimes the identified person may suffer from a certain disease before the injury, but the disease is induced after the injury; Or although you were healthy or unconsciously sick before the injury, you can also have diseases and sequelae after the injury. At this time, the appraiser needs to solve the causal relationship between damage, disease and others, and provide the basis for the case litigation.

(a) the principle of judging the causal relationship between injury and disease.

1. The causality between injury and disease is the connection between objective phenomena: it is a phenomenon caused by injury, which produces or leads to disease, that is, injury is the cause and disease is the result, which is the objectivity of causality. Therefore, to judge whether there is a causal relationship between injury and disease, we must go deep into objective things to investigate and study, that is, to understand the case and the physical condition of the victim before the injury.

2. The difference between injury as a cause and disease as a result is relative, not absolute: only by studying that part of the chain between injury and disease can the causal relationship be clearly expressed, which is called direct causal relationship.

3. There is a time sequence between injury and illness: injury comes first and illness comes last. Therefore, we must look for the reasons from the injuries that occurred before the disease appeared.

4. If the injury is caused by more than one person for many times, identify the degree of injury for each person and each time separately, and distinguish which cause is primary and which is secondary to the occurrence of the disease. So as to determine the primary and secondary problems of the injury of a person, a certain time and a certain part to the disease.

(2) Types of causality between injury and disease: there is no causality between injury and disease; There is a causal relationship between injury and illness, which can be divided into direct causal relationship and indirect causal relationship. At this time, both have inevitability and contingency.

1. Direct causality: This refers to the clinical symptoms such as external force directly acting on human healthy tissues and organs, accelerating the destruction of anatomical structure integrity of tissues and organs, and causing dysfunction. For example, traumatic epilepsy occurs after craniocerebral injury, that is, craniocerebral injury is the cause and traumatic epilepsy is the result, and there is a direct causal relationship between them.

2. Indirect causality: this refers to the external force acting on the original diseased part of the human body. Under normal circumstances, it cannot destroy the continuity and integrity of tissues and organs and cause dysfunction. However, on the basis of the existing potential lesions, the lesions are superficial or more serious. The basic manifestation of indirect causality: (1) inducement: the aggravation of potential lesions induced by injury. For example, the rupture of vascular diseases such as congenital or existing aneurysms after head injury leads to subarachnoid hemorrhage, that is, head injury is the cause of subarachnoid hemorrhage. (2) Auxiliary causes: Injury only plays an auxiliary role in the disease process. For example, the right thigh was kicked and injured by others, and the right thigh continued to have pain and fever after the injury. X-ray shows osteosarcoma, that is, lower limb injury is the auxiliary reason for showing osteosarcoma. (3) The injury involves the behavior of a third party, or the victim's own behavior, or natural factors cause further injury. For example, A was injured by B, and the injury was not serious. However, in the process of hospital diagnosis and treatment, because Dr. C used unsterilized instruments to expand the wound, a wound was infected and complicated with sepsis. Another example is that A injured B, and the wound caused tetanus due to bacterial infection. The above two cases of primary injury have indirect causal relationship with septicemia and tetanus. (4) The damage result of the victim affects the third person, and the damage occurs. For example, a car killed a child, and the child's mother suffered a relapse or mental abnormality due to severe mental stimulation.

skill

Judgment method of causal relationship between injury and illness;

1. Carefully collect and observe the victim's own situation, the time and place of injury, the size, direction, nature, location and severity of external force, and determine the cause of injury.

2. Carefully observe the time, clinical symptoms and various medical examinations of secondary diseases, so as to correctly diagnose the existence of diseases.

3. Applying the theory and technology of medicine and forensic medicine to explore the time interval from injury to onset and the continuity of pathological phenomena; The accidental and inevitable connection between injury and disease. In short, according to the specific analysis of the case, if necessary, turn to the cooperation of professional doctors to diagnose the direct causal relationship between injury and disease. For example, whether the late intracranial hemorrhage is really caused by some external force should be based on (1) and have a clear history of craniocerebral injury; (2) It is necessary to make clear the existence of bleeding, and make a diagnosis through brain cT scanning, pathology and even clinical examination (such as craniotomy and lumbar puncture); (3) There must be a short interval between craniocerebral injury and cerebral hemorrhage, generally no more than 6-8 weeks, but when it comes to a long interval, we should study the sequelae and other issues; (4) No cause of cerebral hemorrhage (cerebral arteriosclerosis, hypertension, cardiovascular diseases, etc.). ) found in the past medical history.

4. If there is a direct causal relationship between injury and disease, the degree of injury shall be assessed in accordance with the relevant provisions of the Criteria for Identification of Serious Injury to Human Body, and the disease caused by injury shall be identified with reference to the relevant contents of the Criteria for Identification of Disability due to Injury, and the total or partial loss of working ability shall be assessed.

5. When there is an indirect causal relationship between injury and disease, the relevant provisions of the human body serious injury appraisal standard are generally not quoted.

6. If there is no causal relationship between the injury and the disease, the human body injury identification standard shall not be cited.

-Quoted from Yanbian People's Publishing House, Master of Law.