Penile strangulation by a metal ring

Penile strangulation due to the metallic ring is an uncommon clinical entity that requires urgent attention to prevent irreversible nerve damage, and if neglected gangrene of the penis. Various methods have been described in the literature for removing constricting foreign bodies, but there is no consensus regarding an acceptable technique. We report the case of a 51-year-old man with a history of a metal ring used for sexual pleasure lodged over the shaft of his penis with an inability to remove the same.

A rare case of neonatal intestinal obstruction

Omphalocele minor is often associated with the presence of other anomalies compared to that of omphalocele major. The occurrence of intestinal atresia is seldom associated with omphalocele minor. Prompt diagnosis and intervention can prevent morbidity and mortality. Following is a rare case report of combination of omphalocele minor and intestinal atresia with strangulation of the proximal bowel.

Use of the amber teething necklace by the child population: risks versus benefits / Uso do colar de âmbar pela população infantil: riscos x benefícios

Abstract Objective: Based on scientific evidence, the objective of the present study is to report the possible risks and benefits of the amber teething necklace for children who use it. Data source: This is an integrative literature review, carried out based on the following guiding question: "Does the amber teething necklace have therapeutic properties that justify its usage during tooth eruption?". The consulted databases were LILACS (Latin American and Caribbean Health Sciences Literature) and PubMed (National Center for Biotechnology Information), with the following descriptors: "Amber," "Deciduous teeth," "Strangulation," and "Local symptoms." Data synthesis: A total of five scientific articles were selected, which indicates an insufficient basis regarding the benefits associated with the use of the amber teething necklace. Conversely, there is a convergence regarding the possibility of health risks such as strangulation, asphyxiation, and swallowing of beads. Conclusions: Health professionals should discourage the use of the amber teething necklace by children insofar more studies on the topic are carried out.

Resumo Objetivo: Com base em evidências científicas, a proposta do presente trabalho é relatar os prováveis riscos e benefícios do uso do colar de âmbar pela população infantil. Fontes de dados: Trata-se de uma revisão integrativa da literatura, realizada a partir da elaboração da questão norteadora: "O colar de âmbar apresenta propriedades que justifiquem seu uso durante a erupção dentária?''. As bases de dados utilizadas foram LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), PubMed (National Center for Biotechnology Information), por meio dos descritores: Âmbar; Dentes decíduos; Estrangulamento; Sintomas locais. Síntese dos dados: Após a busca dos dados, foram selecionados cinco artigos, os quais apontam insuficiente embasamento científico que comprove os benefícios relacionados ao uso do colar de âmbar. Em contrapartida, existe uma convergência quanto à possibilidade de riscos à saúde, como estrangulamento, asfixia e deglutição das pedras. Conclusões: Conclui-se que os profissionais da saúde devem desencorajar o seu uso por crianças até que pesquisas clínicas bem delineadas sejam disponibilizadas.

Hair tourniquet syndrome of labia minora in 14 year teen: a rare case report

Hair tourniquet syndrome (HTS) is rare clinical phenomenon in which body appendage is circumferentially entangled by string of hair leading to ischemia and necrosis or even autoamputation of the appendage. HTS commonly affects toes, finger or genitalia. Early diagnosis and prompt intervention lead to good outcome.  This article presents a case of hair tourniquet syndrome of labia minora, a rare presentation in 14 year child.

Doble mecanismo de estrangulación. A propósito de un caso / Double mechanism of strangulation. Apropos of a case

RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

Unusual Suicide Cases of Asphyxiation by Ligature within the Vehicle / 대한법의학회지

One of the most common methods of suicide is hanging, and suicide by ligature strangulation is quite rare. Vehicles have a confined space, making them an unusual place for committing suicide by hanging or ligature strangulation, because they are more typically the location of suicide by carbon monoxide intoxication by briquette or drug intoxication. Here, we present three cases of unusual suicide by ligature strangulation, discuss the mechanism of asphyxia in each case, and review the literature. In case 1, the victim used a backpack to perform reverse hanging by wrapping the shoulder strap of the backpack around his neck and then tossing the backpack behind the backrest of the driver's seat. In case 2, the victim did not use the internal structures of the vehicle, but pulled down on a ligature wrapped around both his knees and neck. In case 3, the victim hanged himself using a package line fixed to the roof handle grab of the back passenger seat.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Obstructed Obturator Hernia: A Diagnostic Dilemma.

Obturator hernia is a rare type of pelvic hernia which accounts for less than 1% of all abdominal hernias. It generally occurs in elderly emaciated patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common clinical symptom is strangulation combined with mechanical intestinal obstruction. Abdominal CT scan can precisely confirm the diagnosis and early surgical intervention is essential for better outcome.

Retrospective Study of Acute Small Bowel Obstruction: In Eastern India

This is a study conducted in a tertiary care hospital in eastern India aiming to provide detailed description of etiology progression and management of acute small bowel obstruction in our patients. Methods: Around 215 patients presented with features of acute intestinal obstruction.All presented with pain abdomen ,vomiting and distension and constipation. Results: Subsequently 58 patients managed conservatively and rest 157 patients managed surgically.In most of the patients multiple air fluid level are the most common radiological findings.External hernias (34.4%) are the most common causeof acute small bowel obstruction.Resection and anastomosis(24.8%) done in of strangulated bowel and rest are managed by hernia repair, adhesiolysis and stomy formation,Wound infection are the most common post-operative complication. Morbidity(2%) and mortality was mainly due to old age and late presentation. Conclusion: In all cases early diagnosis and surgical intervention are the keys to reduce complications and mortality.

Imaging characteristics and evaluation of strangulated intestinal obstruction / 中国实用外科杂志

Strangulated intestinal obstruction usually starts quickly and changes rapidly.It is a kind of obstruction with hemodynamic disorder, which can lead to serious complications such as intestinal necrosis and peritonitis,and often endanger the life of patients. Therefore,the correct identification and early management of strangulated intestinal obstruction are essential for patients. Imaging examination is widely used in the diagnosis of strangulated intestinal obstruction because it can provide information about the location and cause of obstruction.

Predictive factors with intestinal strangulation and operative intervention for recurrence in adhesive small bowel obstruction / 中国实用外科杂志

OBJECTIVE: To analyze the predictive factors for intestinal strangulation and to identify the surgical intervention for recurrence of adhesive small bowel obstruction(aSBO).METHODS: A retrospective study was conducted according the database in Department of Gastric and Colorectal Surgery, the First Hospital of Jilin University. Patients with aSBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrences after treatment were analyzed by using univariate and multivariate logistic regression model.RESULTS: Total of 288 aSBO patients were included. Thirty-seven(12.9%)patients hadoccurredstrangulatingobstructions,and 251(87.1%)patients had simple obstructions.Increasing heart rate[>100/min;OR(95%CI):4.14(1.31-13.07),P=0.015],increasing WBC count[>15×10~9∕L;OR(95%CI):4.31(1.31-14.16),P=0.016],CT findings of thickening or swelling of the mesentery[OR(95%CI):11.04(2.18-55.92),P=0.004],and CT showing seroperitoneum [OR(95%CI):28.36(9.85-81.66),P<0.01] were detected as independent predictive factors for intestinal strangulation. During the follow-up,84 cases(29.2%)experienced recurrence of obstruction. The recurrence rates were reduced in the operation groups compared with non-operative groups[21.3%(26/122)vs.34.9%(58/166),P =0.01].CONCLUSION: Tachycardia,leukocytosis,CT findings of thickening or swelling of the mesentery,and CT showing seroperitoneum are considered as the predictive factors with intestinal strangulation in aSBO. Meanwhile,surgical treatments can reduce recurrence rate of aSBO patients significantly.

A Complex Suicide by Ligature Strangulation and Hanging Using Two Different Ligatures / 대한법의학회지

Hanging is the most common method of suicide in Malaysia. However, hanging in combination with suicidal ligature strangulation is uncommon. The victim is a 31-year-old man, with no previous medical or psychiatric disorders. He accomplished self-strangulation using a shoelace and hanging himself with a High-Definition Multimedia Interface cable. Three loops of a shoelace ligature were present around the neck. A single knot was present on the front, and a double knot at the back of the neck. Internal examination of the neck revealed small bilateral hemorrhages of the sternocleidomastoid muscles. No laryngeal cartilage or hyoid bone fractures were observed. No other evidence of injury was noted other than moderate pulmonary edema. The post-mortem toxicology results were negative. The cause of death was ascertained as neck compression due to ligatures. Scene assessment and post-mortem findings concur with suicide. This report describes an unusual case of suicidal ligature strangulation, in combination with hanging using two different ligatures.

Estrangulación suicida atípica / Atypical self-induced strangulation

Resumen El hallazgo de un cadáver con signos de suspensión y en circunstancias dudosas plantea la posibilidad de que la muerte esté relacionada a la intervención de terceros. Presentamos el caso de un varón de 36 años que fue encontrado muerto, con una compresión cervical mecánica extrínseca, en una vía pública, sin testigos del hecho. Inicialmente, se investigó el caso como un homicidio, con diagnóstico diferencial de suicidio. El estudio exhaustivo del sitio de la muerte, más el examen post-mórtem completo, incluyendo: autopsia, histopatología y toxicología, permitió descartar la posibilidad de la acción de terceros y confirmar la hipótesis diagnóstica de una estrangulación autoinducida, de ubicación atípica, ejecutada con lazo.

Abstract Finding a suspended body in doubtful circumstances raises the possibility that the manner of death is homicide. We present the case of a 36 years-old male who was found dead, with extrinsic mechanical cervical compression, on a public place, there were no witnesses of the fact. Initially, the case was investigated as a homicide, with differential diagnosis of suicide. The comprehensive analysis of the scene and a complete post-mortem examination: including autopsy, histopathology and toxicology results, allowed us to rule out the possibility of the action of third parties and confirm the hypothesis of a self-induced atypical strangulation.

Severe penile erosion secondary to penile strangulation for 10 years, a reconstructive urological challenge

@#Complications arising from simple surgical procedures such as circumcision are uncommon. When a person devoid of surgical training performs these procedures, severe problems usually occur. This is a rare case of a 23-year-old, Filipino male with severe penile shaft erosion secondary to chronicpenile strangulation from complications of circumcision. A two-stage procedure was planned for this patient involving removal of the constricting object, debridement and anastomosis of the penile shaft. Postoperatively, there was good penile erectile function and an aesthetically acceptable form.

A Post-Mortem Medicolegal Study of Violent Asphyxial Deaths - An Autopsy Based Study

Background: The study was conducted in the mortuary of Babu Jagjivan Ram Memorial Hospital, Jahangir Puri, North-West district, Delhi to determine the frequency and epidemiology of violent asphyxial deaths in that region, in relation to age and gender variation. Duration of study: Autopsies conducted during January 1, 2012 to December 31, 2013. Methods: Out of 2479(two thousand four hundred seventy nine) medico legal deaths autopsied at B.J.R.M. Hospital Delhi, during the study period, details were collected for those medico legal deaths identified to be due to violent asphyxial deaths. Results: 219 out of 2479 medico legal deaths were identified to be violent asphyxial deaths, making incidence rate 8.83%. There were 149(68.03%) males and 70(31.97%) females. Male predominance was seen in all asphyxial deaths except manual strangulation and smothering. Hanging and drowning were leading causes of violent asphyxial deaths. Conclusions: This study concludes that immuno-toxicity by cypermethrin insecticide is not similar in male and female subjects.

Suicidios en Costa Rica durante los años 2015 y 2016 / Suicides in Costa Rica during the years 2015 and 2016

Resumen:La tasa de suicidio en Costa Rica ha sido históricamente menor a 10 casos por cada 100,000 habitantes y se considera menor que en otros paÍses. Existen múltiples factores de riesgo, tanto sociales (pobreza, desempleo, drogadicción) como psicológicos (depresión, duelo), estos son significativamente frecuentes y podrían incrementar estas cifras.Este estudio hace un análisis actualizado acerca del suicidio en Costa Rica, recopilando el número de muertes suicidas en el año 2015 y 2016, siendo respectivamente 318 y 302 casos, obteniendo un perfil del individuo que logró acabar con su vida.Se trató de víctimas predominantemente de género masculino, en edades económicamente activas, con una mayor tasa de mortalidad por suicidio entre las edades 20-60 en el año 2015 y 20-50 en el 2016. El mecanismo más comúnmente utilizado fue la asfixia por ahorcadura, en los meses de enero, junio y diciembre para el año 2015, enero y agosto para el año 2016.

Abstract:Suicide rate in Costa Rica has being historically fewer than 10 per 100,000 habitants, it is considered lower than other countries. Multiple risk factors such as social (poverty, unemployment, drug addiction) and psychological (depression, grieving) are extremely frequent and can be the cause of rise in these numbers.This study is an actual analysis of suicide cases in Costa Rica in 2015 and 2016, 318 and 302 cases in each year, and an individual profile was obtained.Suicide was more frequent in males, in economically active ages, with a higher rate in the age range from 20 to 60 in 2015 and 20 to 50 in 2016. The most common death mechanism was asphyxia caused by strangulation in January, June and December of 2015, January and August in 2016.

Non-aneurysmal and non-traumatic subarachnoid hemorrhage after attempted suicide by incomplete hanging

Hanging is a common method of suicide that is being reported more frequently in many countries. Several complications including injuries to the cervical spine, neck vessels, and brain can occur after attempted suicide by hanging. There are only a few reports of brain computed tomography and magnetic resonance imaging of hanging victims. The most common abnormality was diffuse cerebral edema. A subarachnoid hemorrhage is an atypical complication by suicidal hanging. We report a case of a female patient who presented to an emergency department with altered mental status after attempting suicide by incomplete hanging. The patient was diagnosed with a non-aneurysmal and non-traumatic subarachnoid hemorrhage. This case shows that spontaneous subarachnoid hemorrhage can develop due to a sudden elevation of intracranial pressure, as occurs with hanging.

A case of penile strangulation in a nine year old boy

@#This case report discusses penile strangulation caused by a ball bearing of a fidget spinner in a 9 year - old child. Initial examination revealed a 2 cm x 2 cm metallic ball bearing encircling the base of the penis with gross edema of the distal penile shaft and erythematous penile skin. To release the bearing, a modified string method was used. After removal, skin erosion was treated with debridement and applied with hydrocolloid dressing. Analysis and cross referencing of the case with literature suggest that successful extraction of a constricting object and treatment of penile strangulation, due to the varied nature, causes and effects of penile strangulation, greatly depends on immediate diagnosis and treatment. This spares one from immediate and long term complications, or necrosis with subsequent auto-amputation.

Delayed Pneumatosis Intestinalis Induced by Blunt Trauma in a Strangulated Small Intestine

An ischemia-reperfusion injury of the intestine due to blunt trauma is very rare. Low blood flow can result in an incarceration and an ischemia-reperfusion injury of the small intestine. A 63-year-old woman fell, producing a splenic rupture. Despite the successful angio-embolization of the splenic rupture, the patient continued to suffer from hypotension. During laparotomy to identify the bowel injury, no intestinal perforation was found. However, we found a hemorrhagic infarction of the small intestine with congestion of the submucosal blood vessels. The part of bowel with the hemorrhagic infarction was resected and reconstructed with a jejuno-colic anastomosis. After surgery, she recovered from the trauma and was discharged without complications. We present this ischemia-reperfusion injury of the intestine due to blunt trauma. Meticulous examination and computed tomography scan is mandatory for diagnosis and assessment of treatment outcome.

Establishment of a rat model of superior mesenteric venous thrombosis / 中国比较医学杂志

Objective To establish a rat model of superior mesenteric vein thrombosis by vein ligation and to simulate the pathological process of the disease, and to provide the basis for studies of its pathogenesis and treatment.Methods Ninety-six SPF male SD rats were randomly divided into three groups: Group A (sham operation group), group B (strangulation group) and group C (simple group), 32 rats in each group.Rats in group A were only opened the abdominal cavity but not blocked the blood supply.The rats were sacrificed at 8, 24, 48 and 72 h after operation.The rats in groups B and C were subjected to establish the strangulation and simple models by superior mesenteric vein thrombosis, respectively, and were sacrificed at 8, 24, 48 and 72 h after modeling.Histological changes (H&E staining) in the rat intestinal tissues were evaluated by a pathological scoring system.The levels of intestinal fatty acid binding protein (IFABP) and α-glutathione S-transferase (α-GST) were detected by ELISA.Results The rat model of mesenteric vein thrombosis was successfully established, with a success rate of 100% (96/96).The pathological analysis revealed that compared with the group A, different degrees of blood stasis and injuries were observed in the intestinal tissues of groups B and C, and the injury were gradually increased in the group B, while gradually reduced in the group C.The degrees of blood stasis and injury were positively correlated with the scope of ligation.The result of ELISA showed that the serum levels of IFABP and α-GST of the rats in groups B and C were significantly higher than those in group A (P < 0.05), and the degree of elevation was positively correlated with the scope of ligation.Conclusions In this study, the rat model of superior mesenteric vein thrombosis is successfully established by vein ligation.This model is simple and easy to operate with a high success rate, and can be used in related research.