A comparative study of hanging and strangulation cases based on gross postmortem findings from April, 2021 to November, 2021 in Ethiopia - A cross-sectional study

Abstract

Abstract Background: Hanging and strangulation are two forms of violent mechanical asphyxia due to constriction of the neck and, in practice, the distinction between the two group is very important because strangulation is usually homicidal and hanging in vast majority is considered to be suicidal. Thus, this study was planned to identify gross morphological features in cases of hanging and strangulation and use it, whenever complete information as to the circumstance of death is not provided. Objective: To compare cases of hanging and strangulation, based on gross postmortem findings, presented for medicolegal autopsy to SPHMMC, A.A, Ethiopia. Methods: A comparative, cross-sectional study was conducted from April 1, 2021 G.C. to November 30, 2021 G.C. in the department of FMT, SPHMMC, A.A, Ethiopia. All cases of hanging and strangulation presented to the mortuary of SPHMMC for medicolegal autopsy during the study period were be included. Data was entered and analyzed using SPSS 24. Results: During this period, a total of 2016 cases of medicolegal autopsy were conducted, out of which 94 (4.66%) cases were due to external compression of neck. Out of the 94, there were 83 (88%) hanging and 11 (12%) strangulation (45.5% ligature and 54.55 manual) cases; there was a male predominance with 67% males and 33% females with mean (±SD) age of 34.27 (±14.3). In hanging cases, maximum number of cases were seen between 31-40 years with male predominance 69.9%.; The ligature marks were oblique in 100%, discontinuous in 63.4%, above thyroid cartilage in 85.5% with dry, pale and glistening undersurface in 98.8%. Injuries other than LM were seen in only few cases, external signs of asphyxia were absent in 43.4%, salivary stains in 8.4% and PML over the extremities in 20.5%. Contusion of neck muscles in 4.8% and fracture of hyoid bone and thyroid horn in 10.8% and 3.6% respectively. In strangulation cases, 21-30 years group were most vulnerable with slight female predominance (54.5%); the LMs were transverse in 60%, discontinuous in 60%, at the thyroid cartilage in 100% with contused undersurface in 40%. Injuries other than LM were common, at least 1 external sign of asphyxia was seen in all cases, salivary stains and PML over the extremities in 0%. Contusions of neck muscles were common (72.7%) and fracture of hyoid bone and thyroid horn being 36.4% each. Conclusion and recommendation: Oblique LM, presence of LM above the thyroid cartilage, undersurface of LM being dry, pale and glistening, absence of external signs of asphyxia, presence of dried salivary stains and absence of contusion of underlying neck muscles are suggestive of hanging while transverse LM, presence of LM at the level of thyroid cartilage, contused undersurface of LM and presence of contusions of underlying neck muscles especially the deep ones are suggestive of strangulation. Key words: Medicolegal autopsy, hanging, strangulation, postmortem findings, ligature mark