An Unusual Case of Autoerotic Accidental Hanging or Suicide? A Dilemma

Autoerotic asphyxia is a sporadic form of accidental death occurring from the intentional induction of cerebral hypoxia, most frequently by partial hanging or ligature compression of the neck, to augment sexual arousal and gratification. Fatalities occur when the self-designed release mechanism fails, inhibiting the individual from releasing the neck compression. We report the case of a 60-year-old man who was found partially suspended, unclothed, in his room with a rope tied around his neck, waist and wrists. The ligature passed between his thighs, and its free end was held in his left hand. A detailed medico-legal investigation, comprising crime scene examination and post-mortem examination, discovered findings consistent with death due to asphyxia caused by hanging. However, establishing the manner of death as autoerotic asphyxia was challenging because of the absence of some classical features and the need to exclude other possible manners of death. This case highlights the importance of correlating autopsy findings with meticulous crime scene investigation, circumstantial evidence, and the deceased’s personal, behavioural, and psychosocial history. A comprehensive evaluation of these factors is essential for accurately identifying autoerotic deaths, distinguishing them from suicidal or homicidal hanging, and supporting forensic pathologists in determining the correct manner of death.