Postobstructive pulmonary edema: A fatal complication in suicidal near-hanging

Abstract

Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.

Acute pulmonary edema after hanging attempt.

“…However, the post hanging NPPE is not well known by physicians. In fact, there are few published cases of post hanging NPPE, probably due to the high mortality rate of hangings [1].…”

“…Post hanging pulmonary edema is a Post Obstructive Pulmonary Edema (POPE), which corresponds to a rare form of non-cardiogenic pulmonary edema; it is also known as negative pressure pulmonary edema (NPPE). It is due to an alveolar fluid exudation, that happens after a brutal intra-thoracic depression due to a relief of upper airways obstruction [1]. It is a life-threatening complication that can be secondary to postoperative recurrent paralysis, laryngospasm, obstructing goiter, sleeping obstructive apnea or following suicidal or accidental near hanging or strangulation [2].…”

Post-obstructive Pulmonary Oedema in Delayed Death by Hanging: A Case Report

“…Most of the cases are suicidal, except for a few accidental cases [1]. It is a painless suicide method with immediate death due to reflex vagal inhibition, anoxia, or cerebral ischemia [1,2,3,5]. Though "once launched upon suicide by hanging, there is no retreat", a few patients survive and reach the hospital if promptly rescued, known as 'near-hanging' [1,3,4,5].…”

“…It is a painless suicide method with immediate death due to reflex vagal inhibition, anoxia, or cerebral ischemia [1,2,3,5]. Though "once launched upon suicide by hanging, there is no retreat", a few patients survive and reach the hospital if promptly rescued, known as 'near-hanging' [1,3,4,5]. Those who survive usually die at some later stage termed "delayed death by hanging" [1,4].…”

“…Most patients develop neurological and respiratory complications immediately [3]. Delayed deaths due to hanging occur due to infarction of the brain, hypoxic encephalopathy, aspiration pneumonia, infections, Duret haemorrhage, oedema of the lungs, oedema of the larynx, or pulmonary complications like acute respiratory distress syndrome (ARDS) [4,5]. Post-obstructive pulmonary oedema (POPE), which is a fatal complication, occurs after acute and severe upper respiratory tract obstruction removal [5].…”