Accidental and occupational ligature strangulation in northern Tunisia: four-case study

Abstract Background Death by strangulation is a violent and frequent method of homicides. Strangulation is rarely accidental due to ligature which is caused by a wide variety of objects such as cords, ropes or clothing articles (scarves). It concerns mostly accidents at work, rarely road traffic accidents and domestic ones. We report four cases of occupational and accidental strangulation causing death. Case presentation In our cases, the ligature link was a scarf or a towel. The link was caught on the belt of a tractor in two cases: on a drill pipe and on a combine harvester. Death occurred on site in three cases. The external examination has marked an asphyxia syndrome associated with a large strangulation mark. Furthermore, the autopsy findings have revealed large ecchymotic infiltrations of the neck muscles, a rupture of the trachea, and the oesophagus with a disjunction of cervical vertebra with a contusion of the spinal cord. Conclusions The ruptures of the trachea, oesophagus and cervical vertebra are not classic strangulation lesions but are explained by the brutality and violence of the traction exerted on the neck. We highlight the importance of preventive measures in this accidental type of deaths.