Suicidal Ligature Strangulation without a Knot -A Case Report

Abstract

Keywords: a B S t r a c t Strangulation is a form of death due to asphyxia. Suicide by ligature strangulation is rare & very unique. In suicidal strangulation, the signs of venous congestion are very well developed above the ligature mark. The above said feature is seen where the ligature is twisted several times round the neck, which is followed by a knot. In suicidal strangulation the marks of violence, struggle on other parts of the body are rare and as a rule absent. The following is an unusual case of suicidal strangulation where the victim maintained pressure over neck by pulling the ligature with his left hand. Scene of a crime, relative position of body, absence of violent marks/struggle marks, entangled thread within the grasp of the deceased's hand, past history of suicidal attempt and mental condition of the deceased assisted in arriving at the manner of death. World Health Organization mortality data found that hanging was the most common method used for committing suicide in most of the countries [1]. Literature search suggests that the suicidal hanging is the most common method used in India. Self-strangulation by ligature is uncommon [2]. Strangulation is a type of mechanical asphyxia produced by constriction of the neck by ligature material, without suspending the body [3]. Most of the strangulation deaths are homicidal in nature. Accidental and self-strangulation death are very rare to meet in practice. In the case of suicidal strangulation, there will be no signs of struggle & resistance, the neck including the laryngeal cartilages will not show injury and thus can be differentiated with homicidal strangulation where injuries to the neck musculature are more [2]. Attending the scene of crime, examination of the neck with respect to the pattern, course, position and the method as to how the two free ends of ligature material has been fixed to create constant pressure and constriction of the neck, absences of injuries to other parts of the body, previous history of deceased helps in determining the manner of death. On the perusal of inquest submitted by the investigating officer, the deceased a chronic alcoholic was found in an open field with ligature material present in situ around the neck (Figure 1). The free end of the ligature material was twisted within fingers of his left hand the hand was stretched away from the torso (abducted), made out from the presence of rigor mortis. On further enquiry with the investigating officer, it suggested that one day prior to this fatal incidence; the deceased had carried a sharp cutting weapon (sickle) and threatened to cut his throat in front of his villagers (superficial, parallel incisions noted over the front of neck-hesitation cuts-Figure 4). At that moment, the villagers overcome the deceased and prevented him from getting harmed. Also, the investigating officer could elicit the fact that the deceased suffering from diseases and was thus depressed.

Full text

Suicidal Ligature Strangulation without a Knot - A Case Report
RRMC & H, Mysore Road, Kambipura, Bangalore, Karnataka, India
A R T I C L E I N F O
Keywords:
A B S T R A C T
Strangulation is a form of death due to asphyxia. Suicide by ligature strangulation
is rare & very unique. In suicidal strangulation, the signs of venous congestion
are very well developed above the ligature mark. The above said feature is seen
where the ligature is twisted several times round the neck, which is followed
by a knot. In suicidal strangulation the marks of violence, struggle on other
parts of the body are rare and as a rule absent. The following is an unusual case
of suicidal strangulation where the victim maintained pressure over neck by
pulling the ligature with his left hand. Scene of a crime, relative position of body,
absence of violent marks/struggle marks, entangled thread within the grasp of
the deceased’s hand, past history of suicidal attempt and mental condition of
the deceased assisted in arriving at the manner of death.
*Corresponding author: Kumar PMV, MBBS, MD (Forensic Medicine), RRMC & H, Mysore Road, Kambipura,
Bangalore -74, Karnataka, India
Kumar PMV*, Ahmed N and Rayamane AP
World Health Organization mortality data found that hanging was the most common method used for committing suicide
in most of the countries [1]. Literature search suggests that the suicidal hanging is the most common method used in India.
Self-strangulation by ligature is uncommon [2]. Strangulation is a type of mechanical asphyxia produced by constriction of
the neck by ligature material, without suspending the body [3]. Most of the strangulation deaths are homicidal in nature.
Accidental and self-strangulation death are very rare to meet in practice. In the case of suicidal strangulation, there will
be no signs of struggle & resistance, the neck including the laryngeal cartilages will not show injury and thus can be
differentiated with homicidal strangulation where injuries to the neck musculature are more [2]. Attending the scene of
crime, examination of the neck with respect to the pattern, course, position and the method as to how the two free ends of

of the body, previous history of deceased helps in determining the manner of death.

with ligature material present in situ around the neck (Figure 1). The free end of the ligature material was twisted within

                  

incisions noted over the front of neck -hesitation cuts - Figure 4). At that moment, the villagers overcome the deceased and
   
diseases and was thus depressed.
Citation: Kumar PMV, Ahmed N, Rayamane AP (2014) Suicidal Ligature Strangulation without a Knot - A Case
Report. SAJ Forensic Sci 1(1): 101
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Case Report Open Access
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Introduction
Case report
On external examination, mild subconjunctival hemorrhage noted. Dried blood stains present around oral and nasal region
(due to ant bites). A black thread was present in situ over neck. The free ends of the thread (ligature material) were found

Article history:
Received: 02 June 2014
Accepted: 27 September 2014
Published: 28 May 2015

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noted. The abrasion over the neck was wound twice around the neck. One completely encircling the neck and another
abrasion was wound 3/4th the circumference of neck with a gap noted on its left side. The abrasions were placed one
below the other. A gap was noted for the length of 10cms on the left side of neck and the free ends of ligature material
 

   

the left hand. Ant bites were seen at places over the body. Other external appearances were unremarkable. On dissection
of neck, strap muscles were intact and unremarkable. Hyoid bone and laryngeal cartilages were intact (Figure 5). All
internal organs were deeply congested. Liver was yellowish with feature of multi nodular cirrhotic changes which was

Figure 1: Position of the Body at the Scene of Crime
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Figure 2: Ligature Material In Situ

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Figure 3: Winding of Ligature around Fingers of Left Hand
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Figure 4: Hesitation Cuts

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Figure 5: Internal Findings of Neck Structures
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Discussion

with strangulation [3]. Death by strangulation is homicidal in nature, rarely suicidal or accidental. The distinction between

investigators hastily conclude that self-strangulation is not possible and thus makes it a suspicious death. This may be
true in terms of manual self-strangulation as the constant pressure over the neck cannot be maintained due to loss of
consciousness.
A rudimentary knowledge of neck anatomy is critical in order to understand adequately the clinical features of strangled
victim. The occurrence and degree of mechanical injuries are generally reported to be less marked in suicide, than in
homicide—which is consistent with our case [5].



or ventrolateral position of the knot, the lack of a clear ligature mark, and the absence of defense injuries all characterize a

phenomena: namely, “impaired and obstructed venous return in the presence of continued arterial input” and that “no
relationship exists between the development of petechiae and the presence or absence of asphyxia” [7].
Suicidal neck compression generally has minimal injuries of deep neck structures when compared to the case of homicidal

internal neck injuries like hemorrhages especially surrounding the carotid arteries [9]. As a general rule during post
mortem examination, if a hyoid bone is found fractured the death will be a homicide from strangulation until proven
otherwise [10]. Fracture of the hyoid bone or the laryngeal cartilages are rarely found in suicidal cases and are restricted to
only one broken upper thyroid horn in most instances [11]. A study by Maxeiner showed that fractures of the laryngohyoid
structures seen both in homicidal and suicidal cases, although, in suicidal cases, this is rare and usually limited to the upper
thyroid horn(s) of the laryngeal cartilage [8]. In our case injury to the neck structures and laryngohyoid structures were
absent due to the ligature material being thin and placed well above the laryngohyoid structures.

5
Volume 1 | Issue 1
References
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
35: 294-302.



10. Pollanen MS, Bulger B, Chiasson DA (1994) The location of Hyoid Fractures in Strangulation Revealed by Xeroradiography. J Forensic Sci 40: 303-5.

12. Di Nunno N, Costantinides F, Conticchio G, Mangiatordi S, Vimercati L, et al. (2002) Self-strangulation: an uncommon but not unprecedented suicide

SAJ Forensic Science
The use of more than one ligature has been repeatedly reported in suicides as well as multiple turns [5,8]. It is very
important to examine the knot or other means used to exert pressure over neck and to document its position [12]. In our
case, ligature material was winding twice around the neck with a small gap on the left side. Most of the authors argued that
the presence of knot, half knots as well as double knots should be present in cases of suicidal strangulation. In our case,
constant pressure over the neck was maintained by the ligature which was pulled by the deceased with is left hand. The

This fact was clearly appreciated during autopsy, by the presence of out stretched left arm and the ligature being wound
 
knot is not necessary to maintain the pressure over the neck, as the ligature were held in place by the hands, or by winding
around lower limbs [5,9].
Conclusions
Based on the factors that have to be observed, visit the scene of crime, presence of more than one turn around neck, mode
of application of constant pressure over neck, type of ligature material and past history of the deceased are important to
arrive at the manner of death.
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A thorough death scene investigation, meticulous postmortem examination, past history of the deceased, is essential in
arriving at the manner of death in cases of ligature strangulation. Concluding the manner of death as suicidal has to be
done with precision and upon exclusion of other possible causes.