HANGING

Dosen Penguji: dr.Arista Hardinisa, Sp.F Residen Pembimbing : dr.RP Uva Utomo

Ihsan Bayu Indra Pratama Kartika Linta Isna Regina Fristasari

030.05.110 030.07.117 030.08.134 030.07.144 030.07.212

FK TRISAKTI FK TRISAKTI FK TRISAKTI FK TRISAKTI FK TRISAKTI

Introduction

Hanging cases are the common cause of death as result of asphyxia. Based on facts, hanging is one of suicidal methods which is often found in many countries. In England, there is more 2000 cases of hanging each year. In US, there was 279 accidental death by hanging and strangulation. In Bali, there is 39 suicidal cases and hanging is about 36 cases (in 2009).

Introduction (2)

Hanging can occur in various ages. Formerly, death punishment was established by hanging. It is important to know all about hanging because hanging is very common manner of death which is caused by asphyxia. in medicolegal aspect, as doctor, we must ensure that case is hanging.

Anatomy of the Neck

Definition
Hanging is a form of ligature strangulation in which the force applied to the neck is derivied from the gravitational drag of the weight of the body or part of the body

Classification
A. Mechanism of death: - Suicidal - Accidental - Homicidal B. Victims position: - Complete hanging - Incomplete hanging (partial) C. Place of knot: - Typical - Atypical

Type of Hanging

The victims feet didnt touch the ground

complete hanging Partial hanging

Some part of the body touching the ground

Type of Hanging
Typical Hanging Atypical Hanging

The hanging point is over the occipital area. The pressure of the carotid artery is the heaviest

The hanging point located beside the neck lateral flexion This caused obstruction of the carotid artery and vertebral artery

Cause of Death

Asphyxia

Asphyxia
Tracheal obstruction can develop internally (for example obstruction by foreign bodies), or externally ( for example by rope ). Airway obstruction influenced more in unconsciousness than carotid obstruction

Brain stem and spinal cord injury

This is associated with dislocation or fracture of the cervical vertebrae, for example in judicial hanging, usually occurred in cervical vertebrae C2-3 or C3-4 because of the knot position in the neck. Upper medula spinalis is pulled, stretched, or twisted and pressing the medulla oblongata

Brain Ischemia
Occurred because of obstruction airway. Tracheal obstruction can develop internally (for example obstruction by foreign bodies), or externally ( for example by rope ). Airway obstruction influenced more in unconsciousness than carotid obstruction

Vagal Reflex
Pressure to ganglion nerve of carotid artery by rope that caused vagal reflex, triggered heart beat deceleration. Vagal reflex caused slow arrythmia, then the victim died because of cardiac arrest

Anoxic Anoxia Stagnant

Anemic

Histotoxic

Berat
(Lbs) 14 stone (196 lbs) 13,5 stone (189 lbs) 13 stone

Berat
(Kilogram) 89 kg

Ketinggian
(kaki) 8 ft 0 in

Ketinggian
(meter) 2,44m

86 kg

8 ft 2 in

2,49m

83 kg

8 ft 4 in

2,53m

(182 lbs)
12,5 stone (175 lbs) 12 stone (168 lbs) 11,5 stone (161 lbs) 11 stone (154 lbs) 10,5 stone (147 lbs) 10 stone (140 lbs) 9,5 stone (133 lbs) 9 stone (126 lbs) 8,5 stone (119 lbs) 8 stone 51 kg 10 ft 0 in 3,03m 54 kg 9 ft 10 in 2,98m 57 kg 9 ft 8 in 2,93m 60 kg 9 ft 6 in 2,88m 64 kg 9 ft 4 in 2,83m 67 kg 9 ft 2 in 2,78m 70 kg 9 ft 0 in 2,73m 73 kg 8 ft 10 in 2,68m 76 kg 8 ft 8 in 2,63m 79 kg 8 ft 6 in 2,58m

No 1. 2. 3. 4. 5. 6. 7. 8. 9.

intravital sign non continous circular noose mark and located at upper neck
usually single knot, on the side of the neck Ecchymosys is clearly visible on one side of the noose mark

Postmortem sign Continous circular noose mark, located not too high on the neck
Usually multiple knot, wrapped tightly and located in front of the neck. Ecchymosis on one side of the noose mark is not present or visible

livor mortis is clearly visible above the noose mark and on lower extremities Livor mortis is located on hanged body part fitting with the corpse position after death Parchmentisation (parchment sensation on the noose mark when palpated) Parchimentisation is not present or clearly visible Cyanotic face, lips, ear, etc is very clearly visible Cyanotic face, lips, ears, etc depend on the cause of especially if the cause of death is asphyxia death Swollen face, congestion and protrusion of the Tongue is not sticking out, unless the cause is eyes, accompanied with visible veins on forehead strangulation Tongue could be sticking out Penis erection, semen discharge, and faeces discharge are not present

Penis erection with semen discharge is usually seen on male victim. Faeces discharge may also occured Dribbling saliva is not present on cases other than hanging cases Dribbling saliva on the side of the mouth, vertically to the chest. This is an absolute sign of antemortem hanging

External examination finding

Noose mark - Clear and deep - Diagonal line - Dark brown colored and parchment paper sensation when touched - On the knot area, triangular shape can be seen - The perimeter of the borderline is clearly visible

Asphyxia signs

- Cyanotic
- Vein congestion - oedema

Livor mortis on lower part of the body

Secretion of urine and faeces

Hangmark

Ropes widht

Noose groove

Parchmentisasi

Pale & Oedema face

Cianotic face

SIGN OF ASPHIXIA

Protusion of eye
Tardieu spot

Protrusion of tongue

Neck position

Dribbled down of saliva

Livor mortis

Discharge of sperm, urine, feces, and menstrual blood

Internal examination finding

INTERNAL EXAMINATION

HEAD

Brain congestion and oedema

hemorrhagic spots on meningens

NECK

Tissue under noose mark

Platisma and neck muscle Hangman fracture

Red line

Hyoid cartilage fracture

Larynx and trachea congestion

Tardieus spots on pleura, pericard or peritoneum

THORAX , ABDOMEN, and BLOOD

Organ congestion

Blood in the heart is darker and more dilute

Hangman Fracture
Hangmans fracture results from hyperextension of the upper cervical spine. The axis breaks symmetrically across its pedicles or lateral masses, and the fracture may extend across the posterior part of the body.

 In the second book of Penal Code at Chapter XIX : Matter 338 Matter 339 Matter 340 Matter 344 Matter 345