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Campobasso CP, De Simone M, Porzio A, Mazzini E, Carfora A, Feola A. Suicide by ligature strangulation and/or hanging inside a motor vehicle: a comprehensive review. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00828-1. [PMID: 38760630 DOI: 10.1007/s12024-024-00828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
Suicide by ligature strangulation/hanging inside vehicles is uncommon, and only few cases have been reported in the literature. This study aimed to conduct a comprehensive review of reported cases of suicide by ligature strangulation/hanging inside vehicles, analyzing the features of the death scene, of the ligature and furrow, autopsy findings, and causes of death. The comprehensive review was performed following the PRISMA guidelines by using the most common scientific databases. According to inclusion criteria, a total of 20 cases of vehicle-assisted strangulation/hanging were reviewed: 13 cases were assessed as ligature strangulation resulting in 7 complete decapitations and 7 other cases as hanging. All victims were young or adult males, except for one 48-year-old female. Death was assessed as suicide in all cases, except for a possible accidental autoerotic death. In 8 cases, a history of depression or other psychiatric disorders was reported. Toxicological analysis were positive in 7 cases. Hard ligature materials (nylon, steel, plastic, hemp ropes) were used in most cases, but only 13 cases had a well-demarcated furrow. In 2 cases, no internal findings of asphyxia were found. An additional case of ligature strangulation inside a motor vehicle off is also presented, where no autopsy findings of asphyxia were observed, except for a broad pale furrow and monolateral conjunctival petechiae. This study highlights the challenges in classifying suicidal hanging and ligature strangulation in motor vehicles.
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Affiliation(s)
- Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
| | - Mariavictoria De Simone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy.
| | - Antonietta Porzio
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
| | - Edoardo Mazzini
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
| | - Anna Carfora
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, Naples, 80138, Italy
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Simonit F, Sciarappa OE, Bassan F, Scorretti C, Giudici F, Desinan L. Complex and complicated suicides in Friuli (1993-2017). MEDICINE, SCIENCE, AND THE LAW 2021; 61:14-24. [PMID: 33591875 DOI: 10.1177/0025802420934661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Complex suicides involve more than one suicide method. According to the intention of the victim, they are classified as 'planned' when the use of more than one suicide technique has been previously devised by the victim and 'unplanned' when the first method turns out to be too painful or insufficient to cause death, and the individual then resorts to other means of suicide. Complicated suicide, on the other hand, is a term that was introduced by Töro and Pollak, in which a failed act of suicide is followed by traumatisation, which has a fatal outcome. This type of death must be distinguished from complex suicides. From a sample of 1160 fatalities (837 males) between 1993 and 2017, we identified 20 (1.72%) cases of complex suicide and three (0.26%) cases of complicated suicide. We considered age, sex, psychiatric history, previous suicide attempts, suicide methods and eventual secondary traumatisation. We also compared planned and unplanned complex suicides. The results show a higher number of planned complex suicides (16 vs. 4), a prevalence of males (n = 17) and adults (median age = 48 years, range 21-74 range). Plastic bag suffocation and gas inhalation (n = 8) were the most commonly used methods. Firearms (n = 4) were used exclusively by males in planned complex suicides. Wrist and forearm cuts (n = 5) were found in four unplanned and one planned complex suicides, and all of the cases with known previous suicidal attempts (n = 3) involved planned complex suicides. Complicated suicides concerned three male victims in two failed attempts of hanging and an unforeseen carbon monoxide intoxication following a non-fatal gunshot to the mouth, confirming the rarity of these fatalities.
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Affiliation(s)
- Francesco Simonit
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Orazio Elia Sciarappa
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, Italy
| | - Fabio Bassan
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Carlo Scorretti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Fabiola Giudici
- Biostatistic Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Lorenzo Desinan
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, Italy
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Cordner S, Clay FJ, Bassed R, Thomsen AH. Suicidal ligature strangulation: a systematic review of the published literature. Forensic Sci Med Pathol 2019; 16:123-133. [DOI: 10.1007/s12024-019-00187-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
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Mercè Subirana-Domènech, Prunés-Galera E, Galdo-Ouro M. An uncommon suicide method: Self-strangulation by vehicle-assisted ligature. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2014. [DOI: 10.1016/j.ejfs.2013.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Suicidal ligature strangulation using gymnastics bands. Int J Legal Med 2014; 128:313-6. [PMID: 24429766 DOI: 10.1007/s00414-013-0959-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Suicidal ligature strangulation is a rare event. The most important issue to solve in the investigation is whether it is a case of homicide or suicide. The characteristics of suicidal ligature strangulation are summarized by Koops and Brinkmann with the emphasis on the nature of the ligature instrument(s). In this article, we present two cases of self-strangulation with an almost identical modus operandi using gymnastics bands. The autopsy findings and the nature of the ligature in these cases are depicted and in good accordance with the described typical observations in suicidal cases. The importance of a broad medico-legal investigation is demonstrated.
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