Near-hanging with outliving period: Pathoforensic aspects

Abstract

Introduction Hanging usually ends in death, and about 80% of victims are found dead at the scene of the hanging. However, sometimes the hanging victims overlive for some time, and sometimes even survive the hanging. Objective The aim was to determine the causes of death in near-hanging cases, in people who have been outliving hanging for some time, to explain the pathophysiological mechanisms leading to death, and to identify prognostic factors for this outcome. Methods Retrospective autopsy study was performed for a twelve-year period. There were only seven cases of near hanging. The sample was analyzed according to gender, age, circum-stances of death, and autopsy findings of all observed subjects. The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. Results The sample consisted of five men and two women, average age 48.3±19.9 years (29-81 years). The average outliving period was 3.8±2.6 days (from 7 hours to 7 days). Six people were admitted to hospital in the state of deep coma. In six cases cardiopulmonary arrest occurred after the hanging attempt and all were reanimated for a shorter or longer time until admission at hospital. Conclusion Survival after attempted suicide by hanging occurs extremely rarely. In all the cases, the immediate cause of death after attempted hanging was ischemic brain injury, with a significant and pronounced oedema. In all the cases observed, regardless of the presence or absence of injuries of soft and hard structures of the neck, there was a ligature mark on the neck skin. Acute hemorrhagic gastritis with melaena was present in a significant number of reported cases of near-hanging.