Immersion Deaths in Seoul: Implications of Decomposition for Postmortem Diagnosis of Drowning.

Abstract

Background Drowning is defined as a process of respiratory impairment caused by submersion in water and is a significant cause of death worldwide. However, postmortem diagnosis of drowning remains a major challenge in forensic pathology, primarily because it relies on the exclusion of all other possible causes based on only a few pathognomonic findings during autopsy, particularly in cases involving decomposition. This study reviewed a series of immersion deaths in Seoul by analyzing demographic and epidemiological factors, their associations with the cause and manner of death, and the impact of decomposition on drowning diagnosis. Methods Autopsy data from 113 immersion death cases examined at the Medical Examiner's Office of Seoul National University College of Medicine between April 2016 and October 2023 were collected and analyzed. Drowning findings were assessed with a focus on foam in the airway, emphysema aquosum, fluid in the sphenoid sinus, petromastoid hemorrhage, drowning fluid in the stomach and duodenum, aortic hemolytic staining, and the diatom test results. Results The majority (47.8%) of immersed bodies were recovered from the Hangang River and determined to be drowning suicides. The cases in which the manner of death was undetermined exhibited more advanced decomposition compared to suicides, with epidemiological patterns suggesting social isolation or financial hardship. In terms of drowning findings, decomposition significantly affected the detection of foam in the airway, emphysema aquosum, aortic hemolytic staining, and the diatom test results, whereas other findings, such as fluid in the sphenoid sinus, petromastoid hemorrhage, and fluid in the stomach and duodenum, appeared relatively resistant to decomposition. Conclusion This study outlines the landscape of immersion deaths in Seoul, emphasizing the impact of decomposition on diagnosing drowning and determining the manner of death. Further research is warranted to enhance diagnostic accuracy and to develop standardized guidelines for drowning diagnosis.