The rate of suicide in India has increased in recent years, majority of which is attributed to asphyxial death by hanging. Death by hanging may be suicidal, accidental or homicidal. The circumstances of death are sometimes so strange and bizarre that assessing the manner of death is not always easy. The majority of hanging deaths are relatively straightforward when opining the manner of death, typically determined to be suicide. However, there are rare hanging deaths that require the forensic expert to seek additional information. Accidental hanging is rare. It is rare across all age groups and is even rarer in the adult population. Few cases have been reported in the literature, which describe unusual patterns of accidental hanging. We report an unusual case of accidental hanging in which death of a 25-year-old male occurred due to entrapment of neck in the narrow space between roof and common wall of two adjoining toilets. This case highlights that to evaluate the actual mode and manner of death in such cases, the medico-legal diagnosis is possible with the study of the death scene, the forensic autopsy findings, the toxicological analysis and the study of the circumstances of death.
Hanging is one of the commonest method adopted for committing suicide in India as per the data published by the National Crime Records Bureau (NCRB) India in 2015 followed by poisoning and other methods [1]. It is almost always suicidal and accidental hanging is rare [2,3]. Constriction of the neck by a ligature, where the constriction force is derived from the gravitational drag of the weight of the body or part of it, is called hanging. Accidental hanging can occur without suspension from ligature contrary to the hanging definition. Accidental hangings have a common characteristic that causes death to unsuspecting victims [4]. Accidental hanging is not a means to take one’s life. As the name suggests it is an accidental incident [5]. Accidental hanging usually occurs when adults engage in auto-erotic practices or when children are playing and get entangled in different objects [6]. This case report describes an unusual case of accidental hanging in which wall between two bathrooms acted as a constriction object while deceased’s body weight acted as a constriction force.
Case Description
A dead body of a 25-year-old male was brought to the mortuary of DRPGMC Kangra at Tanda. There was alleged history of death due to entrapment of neck in the narrow space between roof and common wall of two adjoining toilets on the preceding night. As per police investigation, deceased and his brother were going on motorcycle to Jammu. Due to heavy rain and thunderstorm they had stopped at a dhaba to change their clothes. When deceased’s brother didn’t return from the bathroom for quite a long time, deceased tried to look through the wall between the two bathrooms while standing on the flush tank. In the process the flush cover broke and deceased was found hanged (complete hanging) with neck getting entrapped between the roof and wall (Figure 1 and 2). Dead body was referred from peripheral institute for Forensic expert opinion.
Post-Mortem Findings
External Examination: The deceased was a 25-year-old male, 170 cm in length of average built. Face and eyeballs were congested. Nails and lips were bluish discolored. Rigor Mortis was well developed. Post mortem staining was fixed and signs of decomposition were not appreciable.
Figure 1: Look Through the Wall Between the Two Bathrooms While Standing On the Flush Tank
Figure 2: Face and Eyeballs Were Congested. Nails and Lips were Bluish Discolored.
Injuries
Reddish brown abrasion of size 16.5x2.5 cm, oblique, parchmentized, non-grooved and soiled with sand was present over front and left side of neck extending from a point 3.8 cm below and behind left angle of mouth extending towards left side of neck and left mastoid tip. A similar reddish brown abrasion of size 6.5x1.2 cm, oblique, parchmentized, non-grooved and soiled with sand was present over middle and left side of neck uppermost part being 8.5 cm below angle of mouth (Figure 3). Multiple reddish brown abrasions were found over the body externally.
Internal Examination
A 0.2x0.2 cm bluish contusion was present anteriorly over right side of trachea. The autopsy showed a marked asphyxial syndrome associated with diffuse visceral congestion and fluid blood. No other cervical injury was found (Figure 4). Viscera and blood were preserved for chemical analysis.
Figure 3: Multiple Reddish Brown Abrasions Were Found Over the Body Externally
Figure 4: Viscera and Blood Were Preserved for Chemical Analysis
Almost adult hangings cases are suicidal. It is one of the common methods of committing suicide in India. It is considered suicidal unless the contrary is proved. Various atypical forms of hanging occurring accidentally have been described in the literature. Schematically, the survey of these hangings is made according to the age of the victim and the circumstances leading to their death [7,8]. Accidental hanging is rare across all age groups and it is even rarer in the adult population. The adult’s accidental hanging can be “voluntary”, such as in autoerotic asphyxia, but the victim does not expect the death [9]. The adult’s accidental hanging can be really “involuntary” [10]. The most frequent cases reported are in relation with professional or leisure activities (parachuting, mountaineering, etc.). Other circumstances have been described as accidental hanging due to compressing of the neck between the side bars of a bed in elderly subjects affected by neuropsychiatric pathologies [11]. In our case circumstances of death were strange, due to breaking of flush cover and very less distance between the wall and roof, head of the deceased got stuck in the narrow space between the wall and roof. As his feet were not touching the ground, this narrow space acted as compression and his body weight acted as a constricting force.
Hanging is one of the common methods of committing suicide and it is mostly suicidal. Sometimes the bond of the hanging is not a rope or rope like material, but it is about hanging since the constriction of the neck is produced by the weight of the body. In conclusion, in all such cases the study of the death scene, the forensic autopsy findings, the toxicology analysis and the study of the circumstances of death are essential for framing a Medico-legal opinion.
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