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PubMed2001

Laryngeal crepitus: an aid to diagnosis in non-fatal strangulation.

Examination of victims exposed to strangulation is well known in clinical forensic medicine. Not all cases show the objective signs to be found at the examination, e.g. petechial haemorrhages in the eyes and face as well as bruises and abrasions on the neck. In cases without objective signs especially, examination of the laryngeal crepitus might be an aid to diagnosis in strangulation. Laryngeal crepitus is felt by the examiner when the larynx is moved from side to side with a slight posterior pressure. When absent, it is a clinical sign of a mass in the retrolaryngeal space or hypopharynx, probably due to a laryngeal trauma. This paper describes three cases of strangulation where the clinical examinations showed a temporary absence of laryngeal crepitus.

Adult↗

PubMed1992

Suicidal strangulation.

Self-strangulation for committing suicide by the use of ligature is admittedly rare. A suicidal strangulation case from Haryana State, India is discussed in the light of scene of occurrence, investigations of the ligature and its knot. Initially the case was suspected by the police to be a murder, but proved to be of suicidal strangulation.

Adult↗

PubMed2005

Accidental ligature strangulation deaths in East Delhi (India).

Ligature strangulations are usually homicidal. Accidental cases are quite uncommon, especially among adults. A retrospective ten-year study conducted in East Delhi revealed that in a total of 98 cases of death due to strangulation, five cases (approximately 5%) among all medico-legal deaths were of fatal ligature strangulation, involving adults who were neither intoxicated nor indulging in paraphiliac activity. The causative agent in three cases was a cycle rickshaw, in one case it was a rotatory part of a machine, and the fifth case occurred due to entanglement while tying up a cow. The cases and their autopsy findings have been described in this paper, together with the review and preventive aspects of such cases.

Accidents↗

PubMed1982

Transient vocal paralysis following strangulation injury.

Blunt trauma to the larynx, as a source of vocal paralysis, has become an important consideration for the laryngologist. Direct neurologic injury from strangulation by hand is explored with presentation of 4 patients. Three of these had unilateral paralysis; the fourth had bilateral paralysis on two separate occasions of strangulation. All patients recovered in 4 to 20 days. Correlation is made with other acute nerve compression syndromes, and the pathophysiology discussed in light of experimental evidence. Awareness and recognition of this problem in evaluation and treatment of strangulation assault injuries is stressed.

Adolescent↗

PubMed2000

Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990-1997).

OBJECTIVE: To describe the clinical findings in horses with small intestinal strangulation through mesenteric rents, and to determine the recurrence and survival rates after surgery. DESIGN: Retrospective study. ANIMALS: 15 horses with small intestinal obstruction via a mesenteric rent. PROCEDURE: Medical records of horses with obstruction of the small intestine via a mesenteric rent between January 1990 and December 1997 were reviewed. The signalment, history, initial physical examination findings, results of abdominocentesis, and clinical laboratory values were recorded. Surgical findings, including location of the mesenteric rent and surgical procedure performed, were recorded. Short- and long-term survival rates were calculated. RESULTS: Most mesenteric rents were located in the mesentery of the small intestine (13 horses). Two horses had multiple mesenteric defects. Seven horses were euthanatized at surgery because of an inability to reduce the entrapped intestine (3 horses), uncontrollable hemorrhage (2), inability to close the rent (1), and the amount of compromised intestine involved (1). Seven horses required intestinal resection and anastomosis. The median length of intestine resected was 2.6 m (range, 0.6 to 4.5 m). The mesenteric rents created during resection were not closed in 2 horses. One of these 2 horses subsequently developed a strangulating obstruction through the open rent. Seven of 15 horses in our study were discharged from the hospital (i.e., short-term survival rate of 47% [7/15]). Long-term follow-up information was available for 5 of the 7 horses (follow-up duration of 5 months to 9 years), of which 2 died as a result of colic, and 1 horse was euthanatized because of severe arthritis (i.e., long-term survival rate of 40% [2/5]). CONCLUSIONS AND CLINICAL RELEVANCE: Inability to reduce the intestinal obstruction, severe hemorrhage from the mesentery, and the length of intestine involved are the main factors that decrease survival rates in horses with small intestinal strangulation caused by mesenteric rents.

Animals↗

PubMed2003

Will safety release cords on children's cameras prevent strangulation?

This study investigated the automatic safety release mechanisms on neck cords for children's cameras. The purpose of the safety release mechanism is to reduce accidental strangulation associated with children's toys that have neck cords. The horizontal pull forces that activate the automatic safety release mechanism were measured for two different styles of release mechanisms for neck cords. When these forces were compared to forces associated with child strangulation, the automatic safety mechanisms released at higher forces than the forces associated with accidental strangulation or death, which is contrary to what was intended and creates a false sense of security for parents who select a toy camera with such a device.

Accident Prevention↗

PubMed2000

Patient presentation, angiographic features, and treatment of strangulation-induced bilateral dissection of the cervical internal carotid artery. Report of three cases.

Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases. Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired. These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

Adult↗

PubMed1975

Radical emergency operation for prolapsed and strangulated haemorrhoids.

Conservative treatement of prolapsed and strangulated haemorrhoids is still widely used. According to several recent publications, however, emergency operation is a reasonable, safe, and effective treatment. Twenty-five patients with prolapsed and strangulated haemorrhoids underwent operation by the Milligan method. The results are compared with those in a similiar group having elective operation of chronic haemorrhoids. Since there were no differences in postoperative complications, length of stay in hospital, period off work, or late results, and since conservative treatment entails lengthy, painful treatment in bed and a long period off work, emergency operation is recommended for all strangulated haemorrhoids.

Emergencies↗

PubMed1976

The importance of clostridia in experimental intestinal strangulation.

Hemorrhagic and ischemic strangulation of closed intestinal segments was sutdied in germ-free rats individually monocontaminated with one of eight separate species of clostridia. Ischemic strangulation was found to be as deadly as hemorrhagic strangulation in the presence of clostridia. Some clostridia were very toxic whereas others were relatively innocuous. The clostridia, ranked in the order of decreasing lethality, were: Clostridium perfringens type A, C. septicum, C. histolyticum, C. haemolyticum, C. bifermantans, C. sporogenes, C. tertium, and C. novyi type A. All species were readily established in the gastrointestinal tract of the nonoperated germ-free rat. The clostridia appear to be one of the most potentially lethal groups of organisms commonly found in the intestinal tract of human beings and animals.

Animals↗

PubMedDate not supplied

[Possibilities of ultrasonography in the differential diagnosis of strangulation and obturation forms of commissural small intestine ileus].

The main aim of this paper, by the authors' intention, was to attempt to study and provide evidence for that routine transabdominal sonography has great capacities in diagnosing small intestinal strangulation and obstruction ileus caused by commissures or tumors. The data of 48 cases of small intestinal ileus (27 of its strangulation form and 21 of its obturation one) were analyzed. The paper details guidelines on ultrasonographic techniques and the ultrasound semiotics of this pathology. It is the first time that the authors give individual methodological and semiotic approaches at sonography in this group of papers. They present a particularly clinical picture in combination with ultrasonographic data by providing their constant comparison, which serves as an additional support of the results of this paper. In the authors' opinion, the findings suggest that transabdominal sonography may be a successful basic diagnostic technique for strangulation and obturation forms of small intestinal ileus.

Adolescent↗

PubMedDate not supplied

Strangulation injuries of the glans penis: a case series.

Penile strangulation is a devastating injury with a spectrum of causes and possible outcomes. Causes can be intentional or unintentional. Objects such as ball bearings, rings, condoms, and rubberbands have caused this condition, as have hair and plastibell rings. This article describes the cases of five patients with strangulation injuries of the penis. For each case, the cause of strangulation, the treatment and the outcome are presented.

Adult↗

PubMed1991

[Crural hernia, strangulation and surgical treatment].

Anatomical reasons explain that the diagnosis of femoral hernia is sometimes difficult, that controversies still exist on their treatment and that their strangulation is often ignored. The authors propose some remarks on the anatomy of the femoral canal and the femoral hernias, the repair of the latter, and some of the problems related to strangulating. They conclude that research on the femoral canal and hernias anatomy should be valuable; similarly stimulation of surgeons for a better management of the diagnosis of strangulated femoral hernias and for systematically considering surgical repair of all femoral hernias whatever be the risk, should be beneficial. Lastly they underline that a prospective comparison between prosthetic and non prosthetic repairs of common femoral hernias could be organized easily because they are comparative lesions.

Emergencies↗

PubMedDate not supplied

[Strangulated or impacted diaphragmatic hernias. Treatment of six cases (author's transl)].

The authors report the cure of six recent cases of strangulated or impacted diaphragmatic hernia: 3 post-traumatic, 2 hiatal, one congenital. Strangulation or simple impaction are responsible for ischemic phenomena with necrosis and intrathoracic visceral perforation. Intensive care for respiratory, cardio-vascular and metabolic complications, including gastric aspiration, has transformed the prognosis which was recently so poor in this condition. The thoracic approach is advised for the usual reasons and owing to frequent intrathoracic adhesions. It is also advised for ease of treatment of the strangulated viscus and local septic complications.

Adult↗

PubMed1989

[Mechanical ileus caused by strangulation of the small intestine in a left paraduodenal hernia and in a defect in the root of the mesentery].

A case of mechanical ileus caused by small intestine strangulation into a left paraduodenal hernia and through a circular defect in the root of the mesentery is presented. Whereas left paraduodenal hernia is very rare in the surgical casuistics, its occurrence associated with strangulation through a defect in the mesentery has not been documented up to now to the author's knowledge. The true cause of strangulation ileus was found at operation. Reduction of the intestinal loop from the defect in the root of the mesentery was followed by reduction of the loops from the hernial sac. Both apertures were repaired with great caution using individual sutures without resection of the hernial sac. The early and late postoperative evolutions were uneventful.

Adult↗

PubMed1989

[Mechanisms of the pulmonary congestion in ligature strangulation (VIII)].

The authors observed the localization of adrenaline, noradrenaline and histamine in the walls of splenic and renal blood vessels of ligature strangulated guinea-pigs by autoradiography and immunocytochemistry, and measured the 3H-adrenaline and 3H-noradrenaline contents of the spleen et al.'s tissues of the guinea-pigs sacrificed by ligature strangulation. In both the experimental and control groups, some silver grains were observed in the endothelial cells of splenic central arteries, splenic trabecular veins, splenic venous sinuses and renal interlobular arteries after 3H-adrenaline administrations. In the ligature strangulation, the reactions of histamine exclusively demonstrated in the Weibel-Palade bodies of the splenic central arterial endothelial cells. By radioassay, the 3H-adrenaline contents of splenic and renal tissues were more than the control groups. From the above-mentioned facts, adrenaline-induced constrictions of splenic central arteries, splenic trabecular veins and splenic venous sinuses were recognized.

Airway Obstruction↗

PubMedDate not supplied

A new method for differentiating simple intra-abdominal from strangulated small-intestinal obstruction.

We developed a model that aids in the differentiation of simple from strangulated intra-abdominal small-intestinal obstruction and reached an accuracy rate of 97 percent in predicting strangulated obstruction. Fifty-three criteria were analyzed from the records of 229 patients and by the Bayes statistical mode; five statistically significant criteria were identified. Using these, and another 16 criteria that indicated trends, we were able to predict strangulated obstruction with a 97 percent accuracy. Neither laboratory tests nor abdominal roentgenography aided in the diagnosis.

Aged↗

PubMed1989

[Mucosal hemorrhage of the larynx in strangulation and other causes of death].

Report of the occurrence of bleedings (petechiae, ekchymoses and large bleedings) of the laryngeal mucosa in cases of attacks against the neck (strangulation by hand or ligation, blunt forces; n = 110) and in a continuous series of autopsies of medicolegal cases (natural and violent deaths; n = 1000). In this series altogether in 5.6% bleedings were present; in natural death (5.5%) mostly petechiae due to congestion, in death by force (5.8%) hemorrhages due to direct or indirect laryngeal trauma. A frequent cause of laryngeal bleedings was intubation during reanimation. In the section of strangulation mucosal hemorrhage was present in every second case (altogether 68 cases): petechiae (n = 30), ekchymosis (n = 10), both types together (13) and large bleedings (n = 15), mostly in the elastic conus. Special types are symmetrical bleedings of the vocal folds and/or the deeper parts of the laryngeal mucosa as a result of lateral laryngeal compression (they point at airway obstruction); furthermore lare hemorrhages behind (and insides) the PCA muscles following pressure of the larynx against the spine. With increasing intensity of laryngeal compression (especially due to cricoid fracture) rises the portion of broad extravasates; petechial bleedings most frequently are in strangulation by ligature.

Hemorrhage↗

PubMedDate not supplied

[Morphologic findings for airway occlusion in strangulation].

Report of two cases of strangulation by hand. There were large submucous bleedings of the larynx (both sides of conus elasticus) of symmetrical arrangement, near the vocal processes of the arytenoid cartilages. They are believed to be the result of the violent contact of the vocal folds during laryngeal compression; perhaps while the arytenoid cartilages were subluxated inwards and downwards. Bleedings like this indicate the closure of the airway. In one case (50-year old woman) the ossified cricoid was broken; in the other (21-year old woman) the elastic laryngeal skeleton was intact, but large bleedings of the deeper tissues of both vocal folds indicated the vehement compression too. The analysis of 110 cases of attack against the neck (strangulation by hand -n = 30- or ligature -n = 30- alone or together -n = 32-; blunt force: n = 8, other types: n = 10) showed in 7 additional cases less typical but similar bleedings, especially in strangulation by hand.

Adult↗