423 Med Arh. 2012 Dec; 66(6): 423-424 • CASE REPORT An Uncommon Suicide Method: Self-Strangulation DOI: 10.5455/medarh.2012.66.423-424 Med Arh. 2012 Dec; 66(6): 423-424 Received: August 18th 2012 Accepted: October 25th 2012 CONFLICT OF INTEREST: NONE DECLARED CASE REPORT An Uncommon Suicide Method: Self-Strangulation Nursel Turkmen 1 , Bulent Eren 2 , Zehra Demiroglu Uyanıker 3 , Akça Toprak Ergonen 3 Uludag University Medical Faculty, Forensic Medicine Department, Council of Forensic Medicine of Turkey, Bursa Morgue Department 1 Council of Forensic Medicine of Turkey, Bursa Morgue Department, Bursa Turkey 2 Dokuz Eylul University Medical Faculty, Forensic Medicine Department 3 T he suicide act of self-strangulation must be distinguished from homicide, which needs objective scene investigation, autopsy and anamnesis in order to elucidate the manner of death. A 54-year-old man was found dead in public hospital small mosque. ere was one nylon rope around his neck, tied together with a knot in the front, under the chin, and rope continuing tightly to right ankle supported by the jacket bandaged around right ankle for preventing the sliding of the rope was detected. A proper medico-legal evaluation of the crime scene and postmortem examination with systematical inspection are of great importance in such cases. Key Words: Self strangulation, suicide, medico-legal autopsy. Corresponding author: Bulent Eren, MD. Council of Forensic Medicine, Bursa Morgue Department. Bursa, Turkey. E-mail: [email protected]. 1. INTRODUCTION Self-strangulation for committing suicide by the use of ligature is admit- tedly rare (1, 2, 3, 4, 5, 6, 7). e act of self-strangulation must be distin- guished from homicide because it is be- lieved to be impossible to perform this act without assistance. e proper scene investigation, autopsy and anamnesis in order to elucidate the manner of death are of great importance in such cases. is case is presented because of it’s rar- ity among asphyxia deaths. 2. CASE REPORT We report a case of self-strangula- tion in which the crime scene examin- ers had initially suspected homicide but after complete investigation eventually reported the case as suicide. 54-year- old man was found dead in public hos- pital small mosque. e crime scene in- vestigation showed no signs of external force, also there were no signs to sup- port the hypothesis of an attack on the victim. e body was lying supine on a carpet, with twisted knee in the center of the small mosque. ere was one ny- lon rope around his neck, tied together with a knot in the front, under the chin, and rope continuing tightly to right an- kle supported by the jacket bandaged around right ankle for preventing the sliding of the rope was detected (Figure 1). Hypostasis and rigor were present. e face was congested, the lips were cyanotic, and there were subconjunc- tival petechiae. After complete scene investigation, suicide letter appealed to the children was found. Gross examina- tion, after removal of the ligature on the neck, revealed a sharp and linear 0,5 cm clear ligature mark on the strangulation level on the neck (Figure 2). According to the family members’ anamnesis, the Figure 1. The victum lying prone on a carpet
Transcript
423 Med Arh. 2012 Dec; 66(6): 423-424 • CASe RepORT
an Uncommon suicide method: self-strangulation
DOI: 10.5455/medarh.2012.66.423-424Med Arh. 2012 Dec; 66(6): 423-424Received: August 18th 2012Accepted: October 25th 2012
CONFLICT OF INTEREST: NONE DECLARED
CaSe rePOrt
An Uncommon Suicide Method: Self-StrangulationNursel Turkmen1, Bulent Eren2, Zehra Demiroglu Uyanıker3, Akça Toprak Ergonen3
Uludag University Medical Faculty, Forensic Medicine Department, Council of Forensic Medicine of Turkey, Bursa Morgue Department1
Council of Forensic Medicine of Turkey, Bursa Morgue Department, Bursa Turkey2
Dokuz Eylul University Medical Faculty, Forensic Medicine Department3
The suicide act of self-strangulation must be distinguished from homicide, which needs objective scene investigation, autopsy and anamnesis in order to elucidate the manner of death. A 54-year-old man was found dead in public
hospital small mosque. There was one nylon rope around his neck, tied together with a knot in the front, under the chin, and rope continuing tightly to right ankle supported by the jacket bandaged around right ankle for preventing the sliding of the rope was detected. A proper medico-legal evaluation of the crime scene and postmortem examination with systematical inspection are of great importance in such cases. Key Words: Self strangulation, suicide, medico-legal autopsy.
Corresponding author: Bulent Eren, MD. Council of Forensic Medicine, Bursa Morgue Department. Bursa, Turkey. E-mail: [email protected].
1. INTRODUCTIONSelf-strangulation for committing
suicide by the use of ligature is admit-tedly rare (1, 2, 3, 4, 5, 6, 7). The act of self-strangulation must be distin-guished from homicide because it is be-lieved to be impossible to perform this act without assistance. The proper scene investigation, autopsy and anamnesis in order to elucidate the manner of death are of great importance in such cases. This case is presented because of it’s rar-ity among asphyxia deaths.
2. CASe RepORTWe report a case of self-strangula-
tion in which the crime scene examin-ers had initially suspected homicide but after complete investigation eventually reported the case as suicide. 54-year-old man was found dead in public hos-pital small mosque. The crime scene in-vestigation showed no signs of external
force, also there were no signs to sup-port the hypothesis of an attack on the victim. The body was lying supine on a carpet, with twisted knee in the center of the small mosque. There was one ny-
lon rope around his neck, tied together with a knot in the front, under the chin, and rope continuing tightly to right an-kle supported by the jacket bandaged around right ankle for preventing the sliding of the rope was detected (Figure 1). Hypostasis and rigor were present. The face was congested, the lips were cyanotic, and there were subconjunc-tival petechiae. After complete scene investigation, suicide letter appealed to the children was found. Gross examina-tion, after removal of the ligature on the neck, revealed a sharp and linear 0,5 cm clear ligature mark on the strangulation level on the neck (Figure 2). According to the family members’ anamnesis, the
Figure 1. The victum lying prone on a carpet
424 Med Arh. 2012 Dec; 66(6): 423-424 • CASe RepORT
an Uncommon suicide method: self-strangulation
victim had attended to commit suicide and was treated in psychiatry depart-ment of the local public hospital sev-eral years ago. Relatives also stated that a several months before death, the vic-tim had been getting worried for the repayment of the bank credit. Foren-sic autopsy revealed the signs of death resulting from asphyxiation, like con-gestion of the vessels of the neck, pete-chiae of the pleural serosa, pulmonary edema, echimose on the left upper thy-roid horn, but no signs of external trau-matic lesions were detected. The toxi-cological examination did not demon-strate any of the substances screened for in systematic toxicological meth-ods. For scientific explanation of these unusual cases, collaborative work be-tween investigative and medico-legal experts is essential.
3. DISCUSSIONDifferent methods for committing
suicide have been reported in medico-legal literature, but self-strangulation is one of those may be easily be mis-taken with homicide (1, 2, 3, 4, 5, 6, 7). There is belief that strong pressure is needed on the neck for obstruction of the airways and the arterial vessels of the neck. In the medicolegal literature some investigators believe that it is im-possible to performe self-strangulation as an act of suicide (7). Also it is stated that self-ligature strangulation is pre-vented as the individual becomes un-conscious as the venous circulation is
obstructed, leading to relaxation of the ligature tension (2, 4). In contrast with these studies Polson (8) has demon-strated that a force of only 3.2 kg is su-ficient to occlude the airways, besides according to a different investigation a force of 2 kg was detected to occlude the cervical venous vasculature (9). The pressure on the neck by the nylon rope resulted in the classic sign of strangu-lation congestion of the face, petechiae at the level of the subconjunctiva, and pleural and pericardiac serosa, as well as nonspecific signs of asphyxia. (1, 2, 3, 4, 5, 6). On the other hand in some cases it was reported that the response to the compression of the neck causes rapid death from cardiac arrest caused by vagal inhibition, which prevents de-velopment the signs of stasis and in-creased blood pressure could (10). Our case had a chronic psychiatric condi-tion, and history of suicide attempt as it has been described in the different cases in the medicolegal literature (4, 6, 11). Maxenier and Bockholdt, reported that bleedings in the neck muscles seldom occurred in suicides, also detected that the laryngohyoid injuries can be help-ful in the differentiation of suicide from homicide, if more than a single thyroid horn fracture or a laryngeal soft tissue trauma is investigated during autopsies (2), on the other hand Claydon stated that in self strangulation cases laryn-geal fractures were rarely detected and injuries were only mild (1), as it was in-vestigated in the presented case where only small echimose on the left upper thyroid horn was described. Analysis of the literature showed that in the reports that included a description of the posi-tion of the knot, this position was often anterior (3, 4, 5, 6) as in the presented case the nylon rope with a knot in the front of the neck was examined. The lig-ature in suicidal strangulation may be knotted or tightened like a tourniquet. As the ligature is tightened the face and neck may become congested due to slow venous compression (1). And this ob-servation may be important as a clue in the investigation of a case and may
help in narrowing a differential diagno-sis that includes suicide and homicide (4). There were no signs of enforcement on the small mosque door or the win-dows, also there were no signs of strug-gle, or lesions caused in selfdefense in our case. The lack of traumatic lesions exept from the strangulation mark, the negative results of toxicologic analysis, also the presence of the suicide letter to the children, all revelaed the manner of death as suicide. Detailed examination of the scene and of the deceased per-son, collaboration and information ex-change among investigators and foren-sic specialists will help for the correct interpretation of these interesting cases
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Figure 2. Gross autopsy examination; ligature mark on the neck
