Forensic Investigation of Hanging Cases: A Comprehensive Review of Scene Examination, Autopsy Findings, Differential Diagnosis and Modern Forensic Approaches

Abstract

Hanging is a form of mechanical asphyxia in which compression of the neck by a ligature occurs under the influence of the body weight or a portion of the body weight. Although hanging is frequently encountered in forensic practice, determination of the cause and manner of death may be challenging, particularly in cases involving partial suspension, atypical ligature marks, decomposition, intoxication, or associated traumatic injuries. A reliable forensic investigation requires systematic documentation of the scene, examination of the suspension mechanism and ligature, detailed external and internal examination at autopsy, appropriate toxicological and histopathological investigations, and correlation with investigative information. The presence, morphology, and distribution of a ligature mark should not be interpreted in isolation. Modern approaches involving postmortem computed tomography, digital photography, three-dimensional documentation, molecular and biochemical investigations, and advanced toxicology may provide additional information in selected cases. This review summarizes the major forensic principles involved in the investigation of hanging cases, discusses the interpretation of scene and autopsy findings, highlights important differential diagnoses, and examines emerging technologies that may improve the accuracy and reproducibility of forensic opinions.