This week's question is from Erin Cole, who writes mystery and horror and recently debuted her novel, Grave Echoes. Hooray for Erin!
"Unfortunately, my character must die a gruesome death, but by natural causes. Frankly, it needs to be bloody, so that it looks like a murder. I thought that maybe she could die of electrocution in the bathtub, and then because she was taking large doses of probiotics, her body (excuse the gore here) rather explodes (due to the yeast in the probiotics and the heat of the bath). Is this medically possible?"
Great question Erin.
What might cause a grisly death scene that looked like foul play was at hand, but really wasn't?
A few things immediately stuck out as possibilities.
1) Hematemesis (Fancy word for vomiting blood). You could die from a bleeding, broken blood vessel high up in the gut (stomach, esophagus). The blood fills the stomach and it causes vomiting, which as you can imagine, would create a horrific scene. Sadly, I've seen this myself, and yes, it can appear like a massacre took place. The number one cause has often been cirrhosis of the liver (liver failure from diseases, such as long standing alcohol abuse or viral hepatitis, which eventually causes certain blood vessels in the body to expand and bleed. The also have accompanying problems with their innate ability to stop bleeding, which makes the problem worse). A stomach ulcer that eroded through a blood vessel could also cause hematemesis, but less likely death.
So for Erin's character, a past history of alcoholism and markers of cirrhosis (little pink blood vessels over the skin [called spider hemangiomas], flushed palms, distended abdomen, jaundice) might be evident and yet still easy to conceal.
2) Boerhaave Syndrome. This is perforation, or ripping of the esophagus (the tube that connects your throat to your stomach). It occurs with severe retching and vomiting. It can be a cause of death in someone with bulemia, for instance. The death rate of this, untreated, is very high. To make the scene kind of gross for Erin's case, there might be vomitus mixed with blood at the scene of death. Or if the person does not die immediately, they would soon succumb to breathing problems, shock and then death. It's not nearly as messy as being caused by #1, and thus a less ideal choice for the character.
3) But what about exploding guts? If you remember my forensics post, a dead body at some point will bloat from the gases formed by bacterial decomposition. Many of these bacteria are naturally occurring, but eating lots of probiotics probably won't make you more aggressively decompose.
Furthermore, the body has many layers of fascia, muscle, and skin that keeps the abdomen a neat and tidy compartment. Even with severe bloating in decomposition, the belly probably won't explode, especially in a fresh post-mortem scene.
Erin would have to concoct a way for the person's belly to be partially penetrated/torn/stabbed during or just after death, and the body would have to be discovered days later. Perhaps sooner, if a warm environment sped up decomposition. This way, the abdominal contents would have time to decompose to the point of expanding and popping outside of the abdominal compartment through the wound.
I've heard of exploding guts causing death, but it's only happened when the layers of abdomen were compromised, such as at the onset of surgery. I once heard of a case where a patient who had such severe constipation (yes, really, really, really bad constipation can indeed kill--sorry for all the hypochondriacs out there) but this is extremely rare.
Thanks Erin for the great question, and sorry to all of you who just read this over breakfast (a frequent apology here at Medical Mondays, unfortunately!)