Fatal rhabdomyolysis after torture by reverse hanging
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CASE REPORT
Fatal rhabdomyolysis after torture by reverse hanging Michael S. Pollanen1,2
Accepted: 2 February 2016 Ó Springer Science+Business Media New York 2016
Abstract Purpose Reverse hanging (also known as Palestinian hanging) is a form of positional torture where the victim is suspended for a prolonged period of time by the wrists, after the wrists are bound at the back. We report the first autopsy case of reverse hanging. We have discovered that fatal myoglobinuric renal failure due to rhabdomyolysis can be a complication of Palestinian hanging. Method An adult detainee, who underwent interrogation by authorities, was admitted to hospital from a prison and died in hospital after a few days. Death was due to myoglobinuric renal failure. An autopsy was performed. Results At autopsy, the body showed anasarca due to renal failure. There were healing ligature marks on the wrist and forearm, but no blunt impact injury to the shoulders or arms. There was extensive necrosis of the pectoralis major, biceps, and deltoid muscles, organizing hemoarthrosis of the right glenohumeral joint and hemorrhage into the joint capsule of the both glenohumeral joints. The kidneys showed evidence of myoglobin deposition grossly. The overstretching of the major muscles of the shoulder, in response to the prolonged Palestinian hanging, gave rise to the muscle necrosis. Conclusion This case underscores the importance of conducting autopsies on people who die in custody, particularly if detained at times of political instability when torture may be practiced by state actors and others. This
& Michael S. Pollanen [email protected] 1
Ontario Forensic Pathology Service, Toronto, ON, Canada
2
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
case also reveals that fatal rhabdomyolysis can occur by positional torture in a stress position, despite the absence of direct trauma due to blunt impacts. Keywords Torture Autopsy Renal failure Rhabdomyolysis
Introduction Since World War II there has been a progressive rise in the application of the medical sciences to support human rights. Specifically, humanitarian forensic science has emerged as a main method to establish the fate of people who go missing or die at times of war and internal armed conflict and when human rights are abused [1–3]. The discipline of forensic pathology, mostly applied to the context of autopsies, has played a decisive role in seeking the truth about deaths in custody and the causes of death for unidentified human remains recovered from mass graves [4]. However, little is known about the pathology of torture. This is because autopsies are seldom conducted on victims of torture, due to the lack of access to the bodies of prisoners who die after their human rights are violated. On this basis, the basic descriptive pathology of the injuries sustained in torture has not been systemically studied in prospective case series. Our knowledge is limited to individual case reports [5, 6] which are often not well
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