ACCIDENTAL LIGATURE STRANGULATION (ALS) : SURVIVAL OF A MINOR

ACCIDENTAL LIGATURE STRANGULATION : SURVIVAL OF A MINOR

Vilas P. Wadile (M. D.), Sarika V. Wadile (MBBS, DGO)

Jeevak Hospital, Dhule, M. S. (India)

Deepali D. More (MBBS, DCH)

More Hospital, Dapoli -Ratnagiri, M. S. (India)

Arun G. Bhoi

Arun’s Institute of  Forensic Sciences, Research and Education, Pune -411 028 (India).

Email : arun.bhoi@gmail.com

(e-J. Foren. Crime Inv. 2013, 9, 1, Art. 1)

Received on : 12^th Dec. 2012.

Accepted on : 16^th Dec. 2012.

ABSTRACT

Accidental ligature strangulation (ALS) is uncommon, as also, survival of a victim in such cases is rare. The ALS is reported here which occurred to a minor girl while travelling on a M/cycle, however, she survived through it. The prominent ligature mark was observed on the backside of her neck. Observations revealed the presence of the petechiae, too.

KEY WORDS

Accident, ligature, strangulation, petechiae, forensic.

INTRODUCTION

Few cases of accidental ligature strangulation (ALS) are reported in the literature. Kohli et. al. [1] and Aggarwal et. al. [2] have discussed accidental strangulation resulted by chunni in a rickshaw. ALS occurred by massage device has been reported by Deidikar R. D. [3]. Gupta et. al. [4] have reported the case of ALS by sari in M/cycle. ALS by crop thrasher [5], electric grinder [6] and ironing machine [7] are also explored in the literature. Strangulation resulted in domestic violence is reported by Richard [8]. Suicidal ALS is explained by Li D. R. et. al. [9]. Human hair has also, stood the cause of strangulation [10]. The case of incomplete strangulation [11] is explained by Amit et. al. Saurabh and others [12] have reported the survival in an accidental strangulation.

We report here the survival of a minor girl went through a  strangle in incomplete accidental ligature strangulation.

HISTORY

A father was carrying his daughter aged about 10 years on the M/cycle to a nearby place. Being winter days the girl had tied headscarf around her head. She was sitting backside of her father on the M/cycle. On the way of destination the M/cycle got a jerk and bumped heavily by which the girl fell down as she was sitting comfortably behind her father on the M/cycle. While falling down the girl’s headscarf got entangled in a rear wheel of M/cycle and she got strangled. By the motion of the wheel the headscarf got pulled heavily resulting in strangling of  girl’s neck. Father immediately stopped the M/cycle and tried to remove the headscarf from the wheel forcibly to make his daughter free from the trap.

EXPERIMENTAL

PROCEDURE : OBSERVATIONS

Strangulation leads to the constriction of a body organ or duct which leads to ligature and the stoppage of the body fluids like blood. Usually ligature marks (bruising of skin) are caused by materials like ropes, wires, cords, garrote, clothes like sari, chunni and scarf involved in the act of strangulation. In severe cases bleeding, stoppage of respiration and blood flow is noticed. Injuries to head, damage to cartilage may also, be seen.

In the subject matter presented here, the patient’s father briefed that she showed slight signs of suffocation when the incidence took place. Examination of a patient showed presence of a prominent ligature mark to the backside of the neck with peeling of skin (epithelial layer) exposing inner muscular tissues, there from (Fig.1).

Figure 1: Prominent ligature mark to the neck back with peeled skin and exposed tissues.

Redness was also, seen around the neck periphery, on the cheek and face. Petechiae (redness due to blood) was seen in patient’s eyes. It was very much prominent in the left eye as in Fig.2.

Figure 2:  Petechiae seen in patient’s eyes with prominence in the left eye.

The ligature was found slightly extending to the frontal throat portion and curved, too. (Fig.3).

Figure 3:   Ligature mark curved and extending towards throat.

The patient examined, herein, did not show swelling nearby ligature, head injuries, bleeding through ears. ENT and surgical findings were normal. No dislocation/damage was noticed to the cartilage bone.

TREATMENT  

Patient was treated with anti-inflammatory and antibiotic drugs, only and  showed the speedy recovery and found very normal in a week’s time.

RESULTS, DISCUSSION AND CONCLUSION

The slight suffocation noticed by patient’s father must have been resulted by the partial constriction of a wind pipe. The mark produced on neck back is seen prominently as ligature strangulation had got enhanced by abrasion – friction resulted by headscarf while the father tried to remove it forcibly from around the neck of the patient girl. Further, the pressure generated at ligature strangulation site had suppressed the blood flow around neck periphery resulting in redness on the face, cheek and neck. Petechiae (redness due to blood) seen in patient’s eyes was also, the result of the same.

It is ascertained that the falling of a girl in head down – face up position created deep abrasion – ligature mark encircling the back portion of the neck as in Fig.1. The ligature found on the neck back slightly extending to the frontal throat portion and curved (Fig.3) is definitely rare and is suggestive of accidental ligature strangulation.

The patient’s immediate survival is  because of immediate steps taken by her conscious father to stop the speedy M/cycle and to make the girl free from the entangled scarf in the M/cycle by removing it out from the rear wheel which restricted the stopping of respiration and blockage of blood flow.

The proper treatment of anti-inflammatory and antibiotic drugs given to the minor brought her to the normalcy in a short span of a time. Thus, the risk of accidental strangulation which could have lead to fatal and complete strangulation was turned in the saving of the life of a minor girl.

REFERENCES

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[8]. Investigating Domestic Violence Strangultion, Richard, Bluesheepdog.com, 2007 Nov. 9.

[9]. Zhao D., Ishikawa T., Quan L., Li D. R., Michine T and Maeda H., Leg. Med (Tokyo) Nov. 2008, 10, 6, 310-15.

[10]. Milkovich S. M., Owens J, Stool D., Chen X. and Beran M., Int. J. Pediatr. Otorhinolaryngol. 2005Dec., 69, 12, 1621-8.

[11]. Agarwal Amit, Ninave Sudhir, Shrivastav Tripti, Sunkara Anil and Agarwal Sachin, Journal of Forensic and Legal Medicine, 2009 Aug., 16, 6, 350-1.

[12]. Chattopadhyay Saurabh and Pal Indranil, Journal of Forensic and Legal Medicine, 2008 Jan., 15, 1, 53-55.