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Suicidal Vehicle-Assisted Ligature Strangulation Resulting in Complete Decapitation: an Autopsy Report and a Review of the Literature

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Suicidal Vehicle-Assisted Ligature Strangulation Resulting in Complete Decapitation: an Autopsy Report and a Review of the Literature Legal Medicine 10 (2008) 310–315 www.elsevier.com/locate/legalmed Case Report Suicidal vehicle-assisted ligature strangulation resulting in complete decapitation: An autopsy report and a review of the literature Dong Zhao a,*, Takaki Ishikawa a, Li Quan a, Dong-Ri Li b, Tomomi Michiue a, Hitoshi Maeda a a Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan b Department of Forensic Pathology, Sichuan University West China School of Preclinical Medical Science and Forensic Medicine, Chengdu, 610041 Sichuan, China Received 13 May 2008; received in revised form 9 June 2008; accepted 11 June 2008 Available online 12 August 2008 Abstract The victim (59-year-old male) used a long hemp rope tied between his neck and a cherry tree while attempting to drive his car away, resulting in complete decapitation. At autopsy, the decapitation wound of the head and the torso corresponded perfectly; a clear-cut severance plane was found at the bottom of the skull. In contrast to suicidal decapitation by hanging and traumatic railway injury, autopsy findings for vehicle-assisted ligature strangulation are rarely reported. A review of the literature concerning suicidal vehicle- assisted ligature strangulation suggested a striking young or adult male predominance, and the wound margins were usually clear-cut with a sharply-demarcated encircling abrasion zone. The present case presented some notable autopsy findings involving wound mor- phology and pathological changes in organs related to the mechanisms of injury and death. Despite complete decapitation, the face was congestive, the lungs were congested with findings of acute respiratory distress, and the brain was markedly swollen with diffuse and severe astrocyte injury, suggesting that asphyxiation was involved in the death before decapitation. Ó 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Vehicle-assisted suicide; Decapitation; Strangulation; Forensic pathology; Trauma 1. Introduction suicidal vehicle-assisted ligature strangulation, reviewing related literature. Decapitation, although not uncommon in a situation of armed conflict, is a rare event in civilian populations. In 2. Case history forensic practice, decapitated bodies are usually associated with accidental explosion or vehicle crashes [1–3]. In the The headless body of a 59-year-old man was found by suicidal context, decapitation as a consequence of violent his wife in his own one-box car, which had crashed onto methods is always a potential for confusion with homicide the barrier of a bridge at the end of the road with the as well as with body dismemberment or mutilation [4–6].In engine still running. On the same evening, before the vic- contrast to suicidal decapitation by hanging and traumatic tim’s death, he quarreled with his wife about their debts, railway injury which have attracted much attention and and then drove his car away alone saying he needed to calm been well reviewed in previous publications [7–9], reported himself down. Shortly thereafter, his wife received a call and discussed here is a decapitation case resulting from from him. Then she heard a crash nearby, and found his car and the body therein as previously described. The well-dressed torso lay prone on the left side front seat next * Corresponding author. Tel.: +81 6 6645 3767; fax: +81 6 6634 3871. to the driver, and the head was recovered below the seat in E-mail address: [email protected] (D. Zhao). the car. A streak of bloodstain was seen along on the road, 1344-6223/$ - see front matter Ó 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.legalmed.2008.06.002 D. Zhao et al. / Legal Medicine 10 (2008) 310–315 311 approximately 10 m in length and 2 cm in width, backward approximately 5.5 and 58.1 kg, respectively. The height from the left side front door. Lying loose at the end of the was about 166 cm tall (head included). The edges of the bloodstain was a double-twisted 1 cm wide hemp rope with decapitation wound of the head and the torso were per- blood but without any substantial knot used as a noose. fectly complementary with each other, as were the broken The double-twisted rope extended approximately 10 m in ends of the cervical organs. Although the skin of the ante- length away from the other end that was tied to the trunk rior neck was slightly abraded with adjacent extension of a cherry tree just off the roadway. wounds and an abrasion on the chin, the lateral and poster- ior neck showed clear-cut margins with an adjacent sharply 3. Autopsy findings demarcated horizontal encircling band-like abrasion on both the cranial and caudal wound edges (Fig. 1). A sternal The victim was completely severed almost at the base of fracture was found with mild hemorrhage, accompanied by the skull. The separated head and the torso weighted corresponding contusional abrasions on the chin (Fig. 1). The severance plane passed through the uppermost part of the neck between the second and third cervical verte- brae, and there was a tear of the intervertebral disc with no associated vertebral fracture. The cervical spine was completely severed at this level together with other cervical structures including vessels, muscles and nerves (Fig. 2). The airway was severed at the level of the tongue root, and fractures accompanying hemorrhage were found in the thyroid cartilage. The face was congestive, and the con- junctivae showed several petechiae. The brain weighed 1630 g, showing marked swelling with edema and conges- tion, as well as flattening of gyri and tentorial herniation. By immunostaining of glial fibrillary acidic protein (GFAP; 6F2, Dako, Glostrup) and S100 (polyclonal rabbit anti- cow S100, Dako, Glostrup), diffuse and severe morpholog- ical changes of astrocytes were detected in the cerebral Fig. 1. Separated head presenting a clear-cut severance plane with extension wounds and irregular laceration at the anterior neck (a); Fig. 2. Completely lacerated common carotid arteries and cervical spinal abrasions on the chin and the margins of severance injury (b); sternal cord (a); hemorrhages in the broken end of the cervical spinal cord by HE fracture between manubrium and mesosternum (c). staining (b). Bar = 1.25 mm. 312 D. Zhao et al. / Legal Medicine 10 (2008) 310–315 white matter (Fig. 3), showing swelling and decrease of 4. Discussion intact astrocytes in the present case, compared with the control one. Based on the above findings, an accident was excluded. The lungs were slightly congested with segmental alveo- There was no evidence of assault based on extensive police lar hemorrhage, and immunostaining of the pulmonary investigation. The manner of death was determined to be surfactant-associated protein A (SP-A; PE-10, Dako, suicide and the cause of death was diagnosed as decapita- Kyoto) showed a granular pattern, suggesting acute respi- tion indicated by vital reactions in the wound as well as ratory distress [10], while such a finding was not seen in signs of external bleeding and neck compression. decapitation death from railway injuries (Fig. 4). Other Despite high suicide rates all over the world, suicidal organs generally appeared pale and bloodless. Toxicologi- decapitation accounts for less than 1% of total suicide [8], cal investigations revealed a moderate concentration of with frequently encountered methods involving railway alcohol in the bilateral cardiac blood (left, 1.9 mg/ml; right, injury [11,12] and hanging [4–6]. Vehicle-assisted ligature 1.8 mg/ml). strangulation, using a rope tied between the neck and a sta- Fig. 3. Diffuse and severe morphological changes of astrocytes microscopically in cerebral white matter of case A (present case, 13-h postmortem) by immunostaining of GFAP and S100 compared with case B of complete decapitation by suicidal train-pedestrian railway injury (65-year-old male, 12-h postmortem). Bar = 200 lm. Fig. 4. Granular SP-A immunostaining pattern in the lung of case A (present case) compared with the membranal pattern of case B of complete decapitation by railway injury (case B shown in Fig. 3). Bar = 200 lm. Table 1 A review of the literature on vehicle-assisted ligature strangulation Case no. Gender, age (years) Ligature (material, length and Wound of the neck Other pathological findings Ref. width, integrality, loop, stationary object tied to) 1 (1985, U.S.A.) M, 67 Hemp, 10 ft long, snapped, A rope abrasion extending from the Hemorrhage in the neck [16] forklift laryngeal prominence to the angle of the muscles and marked jaw. No decapitation congestion of the tracheal mucosa, numerous petechiae of the pleural surface, D. Zhao et al. / Legal Medicine 10 (2008) 310–315 congested lungs, liver and spleen 2 (1993, U.K.) M, 28 Nylon, 5/8 inch wide and 25 ft A sharply defined wound similar to that a [15] long, tree stump administered by a guillotine. Complete decapitation 3 (2002, Australia) M, 33 Nylon, snapped, a post 30 m A parchmented ligature mark around the a [13] away from the car neck, separation of the hyoid bone from the thyroid cartilage with fractures of both, transection of the right common caroid artery and lower pharynx. Incomplete decapitation 4 (2002, Australia) M, 24 Snapped, a loop at its free end, a A horizontal encircling abrasion around a [13] post 80 m away from the car the neck, with the head being attached to the body by a thin strip of fibrous tissue to the ligamentum nuchae. Incomplete decapitation 5 (2005, Germany) M, 43 Metal, 40 m long, a loop at its Clear-cut wound margins with an a [14] free end, a fence 68 m away from adjacent sharply demarcated abrasion the car zone. Complete decapitation 6 (2008, Japan) M, 59 Hemp, 1 cm wide and 10 m long, Clear-cut decapitation injury with an Congested face with several Our case double-twisted without a knot, adjacent sharply demarcated horizontal petechiae in the conjunctivae, cherry tree encircling marginal abrasion zone.
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