Asphyxia
Kevin L. Erskine, Erica J. Armstrong in Water-Related Death Investigation, 2021
Strangulation represents a type of asphyxia in which an object causes compression of the blood vessels of the neck with or without concomitant compression of the larynx or trachea. The major mechanism of death in this type of asphyxia is the impairment of O2-rich blood flow from the heart up through the carotid arteries within the neck and to the brain, giving rise to cerebral hypoxia. This also involves compression of the jugular veins within the neck, thus impeding blood flow from the head and brain back to the heart. It is the venous compression with intermittent or incomplete compression of the carotid arteries that gives rise to petechial hemorrhages of the face and conjunctivae.3 These are seen in homicidal ligature and manual strangulation deaths and occasionally in deaths due to suicidal hanging. Additional examples of strangulation are choke/bar arm hold and a carotid sleeper hold. Manual strangulations are always homicidal in manner since one would be unable to maintain compression of his or her own neck vessels after the loss of consciousness since the hand(s) would fall away at that point. Manual strangulations and homicidal ligature strangulations can be accomplished because there is some kind of disparity between the opposing individuals, such as strength or drug or alcohol impairment (i.e., adult vs. infant, male vs. female, or sober adult male vs. highly intoxicated adult male).
Pressure to the neck and asphyxia deaths
Jason Payne-James, Richard Jones in Simpson's Forensic Medicine, 2019
Manual strangulation is used to describe the application of pressure to the neck using the hands (although some would add forearms/limbs), and is a relatively common mode of homicide, particularly where there is disparity between the sizes of the assailant and victim. The external signs of manual strangulation (Figure 11.7) can include bruises and abrasions on the front and sides of the neck, and the lower jaw; the pattern of skin surface injuries is often difficult to interpret because of the dynamic nature of an assault, and the possibility of the repeated re-application of pressure during strangulation. These signs are often florid in the survivor and may be more pronounced in the fatality where death has not been immediate. It is generally not possible to reliably determine which of an assailant's hands caused a particular set of injuries or how much pressure must have been exerted by an assailant during the process of strangulation based on the injury pattern (as was illustrated in the ‘Barleycorn Public House Murder’, described in Box 11.3). Bruises caused by fingertip pressure (rounded or oval-shaped bruises up to approximately 2 cm in size) and fingernail scratches (linear or crescent-shaped abrasions, imprints or skin breaches) may be seen, the latter being made either by the assailant or the victim (Figure 11.8).
Fatal Pressure Over Neck by Strangulation
Sudhir K. Gupta in Forensic Pathology of Asphyxial Deaths, 2022
Ligature strangulation refers to the fatal compression of the neck by a ligature, where the constricting force is applied externally and is not the weight of the body. Majority of these cases belong to the homicide category. However, very few suicidal and accidental cases have been reported from time to time. Ligature strangulation differs from hanging mainly in the source, amount and direction of the constricting force. Generally in hanging, gravitational drag of the body constricts the vital neck structures, causing the death by different mechanisms as discussed previously. In case of ligature strangulation, the constricting force is generally lesser and insufficient to cause compression of all neck arteries, especially the well protected vertebral arteries. Ligature strangulation always produces some degree of evident congestion above the level of ligature mark unless when reflux cardiac inhibition is the mechanism of death.
The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review
Published in Neuropsychological Rehabilitation, 2022
Helen Bichard, Christopher Byrne, Christopher W. N. Saville, Rudi Coetzer
Although strangulation can result in blunt force trauma to the neck, the method and physiological impact on the brain is different from most TBI. Strangulation can be defined as the external compression of the airway and/or blood vessels, leading to restricted oxygenated blood flow to, and deoxygenated blood from, the brain. This can be achieved with a ligature (garrotting), by body weight (throttling or positional strangulation), or manually. Evidence largely gleaned from autopsies, and from assessing the risk of the “choke hold” carotid restraint used by police, has been able to show the pathophysiology of strangulation, as set out below (Clarot et al., 2005; De Boos, 2019; Hawley et al., 2001; Monahan et al., 2019). Figure 1 serves as reference for the location of the relevant anatomical structures.
Penile reconstruction: An up-to-date review of the literature
Published in Arab Journal of Urology, 2021
Nicholas Ottaiano, Joshua Pincus, Jacob Tannenbaum, Omar Dawood, Omer Raheem
Penile soft tissue injury is another common means of injury. These injuries typically occur by means of strangulation or entrapment. Strangulation is a form of compartment syndrome frequently occurring in adults for means of prolonging erections for sexual gratification. Urgent treatment is required to avoid permanent damage [14]. The treatment of choice often depends on a multitude of factors such as material of the strangulating object and availability of resources. Commonly used techniques are use of cutting devices, string and aspiration method, and degloving operation. The first step in treatment typically starts with application of a lubricant with an attempt of manual removal. This process is usually performed concurrently with the string and aspiration method, where blood is aspirated from the corpora with an 18-G needle to achieve decompression followed by tightly winding string distal to the ringed object in hopes of sliding the ring over the string. If this fails, more drastic measures are taken by means of intraoperative bone or wire cutters and, possibly, power drilling machinery. After object removal, urethral inspection and possible skin grafting may be required depending on the extent of injury [14,15].
Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review
Published in Journal of Obstetrics and Gynaecology, 2019
Goran Augustin, Davor Mijatovic, Bozidar Zupancic, Dragan Soldo, Mario Kordic
Almost all are the first two degrees of injuries; a simple small bowel obstruction and strangulation are present in the more elastic opening—through the vaginal wall. Strangulation is rare and occurs if the opening is tight and not very elastic or the obstruction lasts more than 6 h. Through the gravid uterine opening, only 14% developed small bowel gangrene due to strangulation and none of the patients had a simple obstruction. There are less than 100 published cases of small bowel prolapse through the vaginal wall in the general female population (Croak et al. 2004; Ramirez and Klemer 2002; O’Brien et al. 2002; Quiróz-Guadarrama et al. 2013; Ricotta et al. 2014; Gheewala et al. 2015; Ajjarapu and Mathew 2014; Rolf 1970), and only 10% with small bowel gangrene (Croak et al. 2004; Quiróz-Guadarrama et al. 2013; Ricotta et al. 2014; Gyang et al. 2014; Ho and Lee 2008; Delotte et al. 2005). The only one case of mesenteric stripping (but at 10-weeks of pregnancy) was probably due to the pulling forces following an illegal abortion (Oladapo and Coker 2005). There are no published cases of small bowel degloving injuries through the vaginal wall.
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