A detainee is found dead after being suspended by his wrists, which were handcuffed behind his back, for several hours. At autopsy there are ligature marks over both wrists but no injuries to the neck or chest. The accepted mechanism of death in this form of torture is:
- A Positional asphyxia from inability to expand the chest ✓
- B Fat embolism from wrist fracture
- C Vagal inhibition from carotid sinus compression
- D Acute renal failure from rhabdomyolysis
Correct answer: A. Positional asphyxia from inability to expand the chest
Explanation
Suspension by the wrists bound behind the back, known as Palestinian hanging or reverse hanging, fixes the shoulders and chest wall so that respiratory movements become impossible. Death results from positional mechanical asphyxia despite an open airway, and the neck structures remain uninjured, excluding strangulation and vagal inhibition. Rhabdomyolysis can occur with prolonged compression but is not the classically described mechanism here.
Reference: Knight's Forensic Pathology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.