A 52-year-old man was found dead, already putrefied, in his apartment. He wore women’s underwear with a female wig and a Santa Claus hat. The body was in a kneeling position, hanging by two knotted stockings fixed to a pipe just above him. The stockings were tied to a metal chain wrapping the body from the neck, crossing the thorax, to the hips, and secured by locked padlocks.
Fig.1 Position of the deceased at the death scene.
At autopsy, forensic pathologists had to forcefully remove the chain using a large pair of pliers. From the hips, the iron chain was connected to an unlocked padlock with two other chain strands holding the genitals. On the back, the chain connected the neck to the waist and genital area and was secured with locked padlocks. The chain, once removed, was 250 cm in length (8.2 ft). No previous diseases were reported, and no letter was found.
Fig.2 Anterior and posterior view of the body wrapped by a metal chain from the neck, crossing on the thorax, to the hips.
Postmortem multislice CT scanning was performed. External examination revealed a deep single furrow (made by the chain) forming a loop that ran upward above the laryngeal protuberance. The autopsy showed hemorrhages of the right sternocleidomastoid muscle, fracture of the left thyroid cartilage upper horn, hemorrhages beneath the anterior longitudinal ligament of the thoracic and lumbar spine (i.e. Simon’s bleedings), and hemorrhages within the testicles. Toxicological analyses were negative. The cause of death was hanging due to an autoerotic accident.
Fig.3 The metal chain was secured by locked padlocks, which needed to be forcefully removed.
Autoerotic death is a relatively rare phenomenon characterized by unusual sexual behavior through a wide variety of lethal mechanisms that often involve deprivation of oxygen. Autoerotic asphyxia is a self-induced cerebral hypoxia brought about during autoerotic activities, and generally induced by constriction of the neck or obstruction of the respiratory passages by various means.
Fig.4 Postmortem multislice CT scanning showing the metal chain.
The basic mechanism of sexual asphyxia is the deprivation of oxygen to the central nervous system leading to a rapid disturbance of the central inhibition mechanisms that control sexual function, thus resulting in augmentation of the sexual response in certain individuals. The depletion of oxygen can usually be achieved by self-strangulation, hanging, suffocation with an object like a plastic bag over the head, chest compression, use of gas (e.g. chloroform and nitrous oxide), or volatile chemicals (e.g. isopropyl nitrite and isobutyl nitrite), or a combination of these.
The majority of deaths resulting from such activities are accidental, due to the unanticipated failure of the means used to produce hypoxia or incorrect estimation of the amount of oxygen restriction. Such activities may also lead to serious brain injury. Autoerotic asphyxiation is estimated to cause 500–1000 deaths per year in the United States.
Latest posts
