Forensic and Histopathological Evaluation of Ligature Marks in cases of delayed death due to Hanging: A Retrospective study

Background: Hanging is the most common method of suicidal deaths in India. Almost all cases of hanging are suicidal unless otherwise proved. It takes some time to develop tissue reaction after the body was suspended by a ligature material and its should be confirmed by histopathological examination. Based on the tissue reaction under the ligature mark we can estimate the duration of survival after an attempted hanging. However, the tissue reaction depends on the type of ligature material used and the degree of suspension. The objective of this study is to determine the age, sex, duration of survival, type of suspension and type of ligature material and to correlation between duration of survival and clinical findings and to analyse the study the temporal corelation between duration of survival after attempted hanging and histopathological changes. Material and methods: Retrospective observational study carried out in the Department of Forensic medicine and Toxicology, Karnataka Medical College and Research Institute, Hubballi. The cases were selected based on the history written in form 146 (ii) and the duration of survival after alleged history of hanging and the deceased was treated in the hospital for minutes to days. Results: 12 cases of delayed hanging death were studied. Out of which, 8 (66.7%) were female and the mean age is 31+11.732years. Household fabrics, particularly dupatta (41.7%) and saree (33.3%), were the most commonly used ligature materials. The duration of hospital stay varied; most patients stayed between 3 to 7 days (41.7%). The HPE of the ligature mark Normal epidermis was noted in 16.7% of cases, whereas ulceration and focal ulceration were observed in 16.7% each. Dermal changes, including congestion, edema, focal separation, and haemorrhage, were observed in a minority of cases, with congestion being most frequent (33.3%). Inflammatory cell infiltrates were common, with predominant neutrophils and lymphocytes observed in 41.7% of cases. The cause of death was most commonly attributed to infection of the lungs (41.7%), followed by hypoxic encephalopathy (25%) and asphyxia (16.7%). Conclusion: Histopathological examination of pressure abrasion due to hanging can provide valuable insights into the nature, type of ligature material used and timing of the injury sustained. Determining the survival period and prognosis for patients with hanging injuries can be challenging.