Accidental sexual strangulation

Accidental death by manual strangulation among homosexuals during the act of sodomy is an uncommon event. In our recent case, the pattern of injuries indicates that strangulation resulted from the forearm application on the neck in a manner better known as "choke holding."     

Accidental ligature strangulation due to a roller-type massage device

A case is reported in which a woman was accidentally strangled when her blouse became entangled in a roller-type electric massage device that she was using to massage the back of her neck. Accidental strangulation in adults, outside of the workplace, is uncommon, and to our knowledge this is the first reported case of a strangulation due to this type of device. The findings of this interesting and unusual case are presented.     

Penile strangulation: report of a fatal case

Penile strangulation or entrapment is an unusual entity that requires urgent treatment due to its potential complications. Several cases have been reported in the medical literature, some of them describing serious injuries such as necrosis, gangrene, and amputation of the penis. However, as far as we know, no fatal cases have been described before. We present the death of an adult male secondary to the complications due to penile strangulation with a plastic bottle neck. The time of incarceration was unknown, but according to a witness it could be about 10 to 14 days. The findings of autopsy were penile strangulation, necrosis of the penis, acute pyelonephritis, and bronchopneumonia. The subject's refusal to ask for medical help was the cause of this atypical evolution.     

Ligature strangulation of a woman during sadomasochistic sexual activity

Sadomasochistic sexual behavior can sometimes lead to the death of one of the participants. A case of death by strangulation, occurring during sadomasochistic sexual activity, is presented.     

Hyoid fracture and strangulation.

Observation of hyoid fracture in skeletonized remains offers potentially valuable information on the history of the skeleton or evidence of foul play, or both. Perimortem hyoid fracture frequently indicates manual strangulation, although ligature strangulation, hanging, and other forms of trauma to the neck cannot be ruled out without additional evidence. Such fractures are rare in children and infants, since the hyoid components are not fully ossified and are more flexible than in adults. Both antemortem and postmortem origins of the fractures must also be considered.     

Intra-cartilaginous laryngeal haemorrhages and strangulation

A previously unrecognized laryngeal injury in young female victims of manual strangulation is described. Twelve larynges that were retrospectively and prospectively collected at the Office of the Chief Coroner for Ontario (1982–1997) were used for this study. In all instances, the larynges were from cases of strangulation (mean age 27±10 years, range 20–46) with classical postmortem findings of asphyxia and either manual or combined manual and ligature strangulation. None of the larynges had fractures of the lamina of the thyroid cartilage, superior cornua, or cricoid cartilages. However, in 9 of the 12 cases (75%), sagittal sections revealed multifocal acute haemorrhages into the base of the superior cornua of the thyroid cartilage at the point of origin from the laminae. The presence of acute intra-cartilaginous haemorrhage into the larynx likely represents the disruption of small blood vessels due to elastic deformation of the flexible larynx during strangulation. The recognition of this form of laryngeal injuries broadens the pathological findings in cases of asphyxia associated with pressure on the neck.     

Forensic assessment of survived strangulation

By a retrospective analysis of all survived strangulation cases examined at the Institute of Forensic Medicine of Berne, Switzerland between 1987 and 2002, the authors tried to find out, if findings and symptoms of victims could be related to the fierceness of the assault and the mode of strangulation and if general evaluation criteria could be established on the basis of objective findings. One hundred and thirty-four survived strangulation cases were analysed on the basis of written reports, photographies and schematical sketches. Findings and symptoms reflected the fierceness of the assault in 71% of all cases by displaying a continuum of findings from minor injuries to severe traumatisation. This applied especially for cases of manual strangulation while other modes of strangulation resulted in different constellations of findings. As a result of this study, the authors deem the following classification of three degrees of severity as practical on condition that a complete forensic medical examination was performed upon the surviving victim shortly after the incident of strangulation: Light strangulation, confined to skin abrasions and/or reddening of the skin of the neck. Moderate strangulation, defined as bruising to, and/or bleeding from the neck, and/or damage to deeper soft tissues or the larynx, as exhibited by the symptoms of sore throat, difficulty in swallowing, and hoarseness. Severe, life-threatening strangulation if the victim presents petechial bleedings as a result of venous congestion with or without accompanying loss of consciousness.     

An unusual mechanical asphyxia in a homicide-suicide case by smothering and strangulation

A very unusual homicide of 2 children by smothering and strangulation by means of a rubber adhesive band carried out by the mother who committed suicide by the same manner is presented. Smothering is supposed to be one major cause of death in child homicide. Suicide by smothering is relatively uncommon. Suicidal smothering by winding strips of adhesive tape around the head to cover the nose and mouth is an even rarer method recently described in literature. The circumstances of the crime and the macroscopic and microscopic evidence are discussed to reduce the potential for underdiagnoses or mistakes in such cases in which it may be difficult to establish whether suicide or homicide occurred.     

Morphologic findings for airway occlusion in strangulation

Report of two cases of strangulation by hand. There were large submucous bleedings of the larynx (both sides of conus elasticus) of symmetrical arrangement, near the vocal processes of the arytenoid cartilages. They are believed to be the result of the violent contact of the vocal folds during laryngeal compression; perhaps while the arytenoid cartilages were subluxated inwards and downwards. Bleedings like this indicate the closure of the airway. In one case (50-year old woman) the ossified cricoid was broken; in the other (21-year old woman) the elastic laryngeal skeleton was intact, but large bleedings of the deeper tissues of both vocal folds indicated the vehement compression too. The analysis of 110 cases of attack against the neck (strangulation by hand -n = 30- or ligature -n = 30- alone or together -n = 32-; blunt force: n = 8, other types: n = 10) showed in 7 additional cases less typical but similar bleedings, especially in strangulation by hand.     

Accidental dichloromethane fatality: a case report

A case of accidental dichloromethane poisoning by inhalation is presented. It is of interest that carboxyhemoglobin levels were within the normal range, suggesting that the narcosis and respiratory depression were due to the direct effect of DCM on the central nervous system. The accidental death was attributed to improper ventilation of vapors in the working area.     

Injuries to laryngeal articulations in strangulation and throttling

During the consecutive examination of the larynges of (81) deceased persons (strangulation by hand and/or ligature, blunt force against the neck, from other persons), the cricothyroid and cricoarytenoid-articulations were prepared and opened, and capsular or articular cavity hemorrhaging was found in 30% of all cases; a clear distinction being found between effect of manual strangulation (43%) or blunt trauma (44%) on the one hand and strangulation by ligature alone (9%) on the other. The greater the extent of injury to the cartilages the more articular lesions are found as an expression of the mechanical load on the entire laryngohyoid structure.     

A triad of laryngeal hemorrhages in strangulation: a report of eight cases

The results of histological studies on larynges from eight cases of manual strangulation, all that had intracartilaginous laryngeal hemorrhages, a recently described and under-recognized lesion associated with strangulation, are reported. Formalin-fixed larynges were examined in serial section using a standardized protocol. In all cases, intracartilaginous laryngeal hemorrhages were associated with subepithelial laryngeal hemorrhages, and intralaryngeal muscular hemorrhages forming a "triad of hemorrhages." In five cases, the triad was found in the presence of laryngeal cartilage microfractures. Since cartilage microfractures can be causally related to mechanical injury to the neck, it is likely that the triad of hemorrhages has diagnostic value as an independent morphological criterion for the postmortem diagnosis of strangulation. Since a proportion of cases of strangulation lack characteristics that are self-evidently due to violent application of pressure on the neck, recognition of the triad may have important implications for the postmortem diagnosis of strangulation.     

Histamine effects on pulmonary blood vessels in strangulation

Endothelial cells of asphyxial pulmonary veins possess abundant pores and intracytoplasmic vacuoles. The present radioassay demonstrated an increase in histamine concentrations of the pulmonary tissue in asphyxia. These morphological changes, therefore, appear to represent an enhancement of the endothelial permeability induced by high histamine concentrations in blood plasma. The present immunoelectron microscopy study demonstrated heavy reactions of histamine exclusively on the endothelial surface of the asphyxial pulmonary veins. This may support the endothelial cell-dependent vasodilation mediated by histamine in asphyxial pulmonary veins.     

Catecholamine effects on pulmonary blood vessels in strangulation

Guinea pigs were killed by strangulation to investigate the vasomotor of pulmonary congestion by asphyxia. The noradrenaline uptake by the endothelial cells of the pulmonary arteries and capillaries was observed by fluorescence histochemistry, peroxidase-anti-peroxidase (PAP) immunocytochemistry, and autoradiography. By radioassay, the volumes of noradrenaline uptake by the pulmonary arteries and capillaries in the strangulation group were at a significantly higher level than in the control groups. Many myoendothelial junctions were observed at the sites of constricted arteries, and the invasive noradrenaline was clearly observed in the myoendothelial junction. The mechanism of the pulmonary vasoconstriction in strangulation is due to the fact that the plasma noradrenaline, increased by asphyxia, invades the endothelial cells of pulmonary arteries and capillaries and causes the vasoconstriction.     

Living victims of strangulation: a 10-year review of cases in a metropolitan community

The prevalence of reported domestic violence or intimate partner violence has greatly increased, with approximately 1.5 million women violently assaulted annually in the United States by an intimate partner. Strangulation is often seen in violence against women, including domestic violence cases. Strangulation is defined as "a form of asphyxia characterized by closure of the blood vessels or air passages of the neck as a result of external pressure on the neck." This is a 10-year case review of 102 living victims of strangulation who underwent medicolegal evaluation at the Clinical Forensic Medicine Program at a State Medical Examiner's Office serving Southern Indiana and all of Kentucky. The majority of victims (79%) were strangled by an intimate partner, and manual strangulation was the most common method (83%). A total of 38 victims (38%) described a history of domestic violence, and the same number lost consciousness while being strangled. Nine (9%) women were pregnant at the time of the attack, while 13 (13%) had a history of being sexually abused in addition to being strangled. A paucity of cases involved only strangulation, as most of the victims were subjected to myriad forms of blunt force trauma which included not only the head and neck but also other bodily regions. This is a unique presentation of strangulation of living persons as most evidence of strangulation in the forensic literature has been derived from postmortem examinations of the victims. This comprehensive study discussing the examination of a living strangulation victim offers valuable insight into the mechanism and the physical findings involved in the strangulation process.