Asphyxia is derived from Greek word and literally means pulselessness. However, in forensic practice, the term asphyxia is used to describe a condition in which the supply of oxygen to the blood and body tissues is reduced appreciably below the normal working level by any interference with respiration [1]. Hanging (self-suspension) is that form of asphyxia which is caused by suspension of the body by a ligature which encircles the neck, the constricting force being the weight of the body. A suicide will use any article readily available for the purpose. The ligature mark in the neck is the most important and specific sign of death from hanging [2]. The present case study highlights an atypical case of a long loop of ligature material in-comparison to the neck of the deceased. Detailed discussion related to the various scenarios of ligature loop in relation to neck and its effects are discussed herewith.

A 24 years old male was brought for medicolegal autopsy at our tertiary care centre with a history of suicidal hanging. The body was brought covered in two bed sheets; one was red in colour and the other bed sheet was blue in colour. The deceased was wearing a grey colour winter jacket. He was also wearing black colour full sleeves t-shirt, Blue coloured full pant, Orange colour underwear. Red and black thread was seen around the waist.

On external examination there was yellow coloured nylon rope which was used as ligature material around the neck. The knot of the ligature material was of a fixed type and the knot was present over the posterior aspect of the neck. Length of the loop of the ligature material was 60 cm and it was much more than the neck and it was loosely present around the neck. The loop had 5 free ends. The length of the free ends of ligature material was 154 cm, 162 cm, 165 cm, 167 cm and 150 cm.

There was cyanosis of nails of the hands and feet noted. On removal of the ligature material ligature mark was present over the neck. Ligature mark was present above the level of the thyroid cartilage. Ligature mark was running obliquely upwards and backwards towards the back of the neck. Ligature mark was absent over the posterior part of the neck in the areas of the hairs. Length of the ligature mark was 30 cm and it was absent for the length of 13 cm. Maximum width of the ligature mark was 5 cm present at the front of the neck. Ligature mark was 7 cm below the chain, 10 cm above the sternal notch, 3 cm below the right mastoid and also 3 cm below the left mastoid. Ligature mark was dry, hard and parchment like. There were no any other external injuries.

On dissection of the neck tissue under the ligature mark was found to be dry, whitish and glistening. Thyroid cartilage, cricoid cartilage and hyoid bone were found to be intact. There were no any other internal injuries. All the internal organs were found to be intact and congested.  

Mechanical asphyxia is a broad term in which enough external pressure is applied to the neck, chest or other areas of the body, or the body is positioned in such a way that respiration is difficult or impossible[2]. Death by hanging is due to compression of the neck as a result of suspension of the body by means of a ligature in such a manner that the weight of the body (or a part of the body weight) acts as a constricting force[3]. Ligature material with other factors cause the compression to the neck and produces ligature mark. The ligature mark in the neck is the most important and specific sign of death from hanging. Ligature mark on the neck depends on (1) Composition of ligature (2) Width and multiplicity of ligature (3) The weight of the body suspended and the degree of suspension (4) The tightness of encircling ligature (5) The length of time body has been suspended (6) Position of the knot (7) Slipping of ligature during suspension [2].

The various scenarios of ligature material loop, knot, and position in relation to neck and its effects and resultant production of ligature marks are as below:-

(1) When the loop is arranged with a fixed knot, the course of the mark is deepest and nearly horizontal on the side opposite to knot, but as the arms of the ligature approach the knot, the mark turns upwards towards it. This produces an inverted 'V' at the site of the knot, the appearance of the 'V' corresponding with the site of the knot. An impression from a knot may be found if the ligature is tight on the skin, usually on one or other side of the back and occasionally beneath the chin [2].

(2) In the case of a fixed loop with a single knot in the midline at the back of the head, the mark is seen on both sides of the neck and is directed obliquely upwards towards the position of the knot over the back of the neck[2].

(3) In the case of a fixed loop with a single knot in the midline under the chin, the mark is seen on the back and both sides of the neck, and is directed obliquely forwards towards the position of the knot over the front of the neck [2].

(4) In the case of a fixed loop with the knot in the region of one ear, the mark differs on each side of the neck. On the side of the knot, the mark is directed obliquely upwards to the knot, and on the other side it is directed transversely. If the ligature is in the form of a loop, the mark will be most prominent on the part of the neck to which the head has inclined and less marked over the region of the open angle of the loop [2].

(5) If a running noose fails to tighten, the mark may resemble one produced by a fixed loop. If the noose is a belt, a single ligature will produce two parallel ligature marks, as the upper and lower edges of the belt dig into the skin [2].

Horizontal ligature mark is seen:

(1) When a running noose is applied, the weight of the body will cause the noose to tighten in a mainly horizontal position. The mark is seen on both sides of the neck, and is usually directed transversely across the front of the neck resembling that of a ligature mark in strangulation, except that it is likely to be seen above the level of thyroid cartilage [2].

(2) In hanging from a low point of suspension, the groove produced by the ligature is less well marked, and may be at about the level of the upper border of the larynx and more horizontal [2].

(3) In partial hanging when the body leans forward, a horizontal ligature mark may be seen [2].

The present case study highlights the ligature material in cases of hanging. [4]Found commonest position of the knot was at nape of the neck, followed by the left side of the neck at mastoid process. The number of turns/loops of a ligature around the neck was one turn in 72.4% and two in 25.2% the hanging deaths. [5] found the predominance of a slip (running noose) type of knot followed by a reef or granny knot in hanging deaths. They found that knot was commonly placed on the left side of the neck, followed by the right side and the back of the neck. Also hanging mark was usually being single signifying single turn of ligature loop and hanging mark was lying above the thyroid cartilage. [6] Found sliding type of knot in 70.5% cases. [7] Found fixed knot in 46.3% cases and running type of knot in 53.7% cases. Also hanging mark was usually being single signifying single turn of ligature loop and hanging mark was lying above the thyroid cartilage. [8]Found that the knot was commonly placed on the left side of the neck, followed by the right side and the back of the neck. Also hanging mark was usually being single signifying single turn of ligature loop and hanging mark was lying above the thyroid cartilage. [9] Noted the knot more commonly on the right side followed by the left side.

In the present case the length of the loop of ligature material was 60 cms while the length of the ligature mark over the neck was 30 cm and ligature mark was absent for the length of 13 cm. The length of the loop of the ligature material was very long in-comparison to the neck of the deceased. But as the victim gets suspended from the ligature material the neck of the deceased gets fixed into the ligature material due to gravitational pull and it causes death of the deceased. Detailed analysis of the place of occurrence, the height of suspension, the length of the suspending part of ligature material can give additional information in such cases.

Figure: Deceased of suicidal hanging with long length of the loop of the ligature material.

Conflict of Interest: None.

Acknowledgement: None

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