A 21-year old female student was found unresponsive and hanging from a rope in her hostel room. She was confirmed dead upon arrival to the hospital. The document defines strangulation and describes the key external and internal examination findings in cases of strangulation. Externally, there may be petechiae on the face and neck, swollen lips and tongue, and ligature marks on the neck. Internally, injuries may include bruising of neck muscles, fractures to the thyroid and cricoid cartilages, bruising of the tongue and larynx, and petechiae in the lungs and brain.

1. STRANGULATION
by
Faith Chelangat

2. • A 21 year old female student is found to be unresponsive and hanging
on a suspended rope in her hostel room at 6am on a Thursday
morning. Police are called on site and she is taken to Thika Level 5
Hospital where she is confirmed dead.
a) Describe key findings on external examination in cases of
strangulation
b) Describe key findings on Internal examination in cases of
strangulation

3. • Definition: It is a form of violent asphyxial death caused by
constriction of air passage at the neck by means of a ligature or by
any means other than suspension of the body.
Classification
• Ligature strangulation
• Manual strangulation or throttling
• Mugging
• Bansdola

4. Examination Steps
1. Identification of the patient
2. Clinical history
3. External examination
• General examination the clothing- tears, loss of buttons, holes, sex and age, general
nutrition and physique, state of cleanliness, hygiene, deformities, pallor, jaundice,
lymphadenopathy
• Post-mortem change – the findings will depend on the duration.
• Medical interventions
• Recent injuries
• Medical examination
4. Internal examination

5. • Face is congested, swollen and cyanosed.
• Petechiae are present on the forehead, temples, eyelids and conjunctiva;
more abundant than in hanging
• Eyes are prominent, wide open, conjunctiva congested, pupils dilated and
subconjunctival hemorrhages are present.
• Lips, fingernails and ear lobules are cyanosed; postmortem staining marked
on the skin above the ligature
• Tongue is swollen, dark colored, may protrude out of mouth, and bitten by
teeth
• Bloodstained frothy fluid and mucus may escape from mouth and nostrils

7. Neck Ligature mark (‘furrow’)
• It’s a well-defined groove, which is slightly depressed and of same width
as that of ligature material.
• It is usually horizontally placed across the middle or lower part of the
throid cartilage
• The base of the furrow is usually red, accompanied with congested or
ecchymosed margins
• When both hands are used, evidence of pressure of thumb mark of one
hand and finger marks of other hand are usually found on either side of
throat

9. Other body parts
• Postmortem staining is deep and prominent
• There may be involuntary discharge of urine and fecal matter
• Seminal ejaculation is less common than in case of hanging
• Hands are usually clenched
• In case of struggle, there may be evidence of abrasions, fingernail scratch marks,
and contusions over the face, arms and other parts of the body
• Scratches may be found on the skin of the neck near the ligature. They are
usually horizontal, may be irregular or crescentic abrasions, consequent of the
victim’s attempts to pull the ligature away from the neck
• Fingernails of the deceased should be examined for fragments of skin and blood

10. Internal examination
NECK
• Bruising of the subcutaneous tissue and muscles of neck, especially
underneath the ligature and knot.
• There may be bruising or laceration of the sheath of carotid arteries
• Fracture of thyroid cartilage, one or both the superior horns may be seen
• Subcapsular and interstitial thyroid hemorrhages are common
• Fracture of cricoid cartilage is less common
• Rings of trachea may sustain fracture when considerable force is applied

11. • Bruising of the root of the tongue and floor of the mouth may occur
• Tongue may be bruised/lacerated, may protrude out and bitten by teeth
• Lymphoid follicles at the base of the tongue and the palatine tonsils are
congested
• Mucous membrane of the pharynx, pyriform sinuses, epiglottis and larynx usually
show areas of hemorrhagic infiltration
• Larynx, trachea and bronchi are congested, and contain frothy, often
bloodstained mucus
• Fracture/dislocation of cervical vertebrae is not common, may occur in infants if
associated with twisting of the neck
• Tear/laceration of platysma or sternocleidomastoid muscles may be seen

12. • Inward compression fracture of hyoid bone is the most diagnostic
finding of throttling.
• Lungs are congested, edematous with numerous subpleural petechial
hemorrhages
• Brain is congested with petechiae in white matter.
• All other organs are congested.