A 74-year-old man was found dead inside a closet of clothes in his residence. He was living alone in a single storied town house at suburban area. The police received a report from the neighbors about house breaking. When the police reached in that house, no one was inside. The entrance gate lock was broken. The police had to enter through the broken gate. The belongings were scattered over the floor of the bedroom but did not find the old in the house. On the next day, the police discovered the dead body of the old man in a closet while revisiting the scene [Figure 1a]. His mouth and nose were covered by a black plastic bag. The open ends of the bag were tied at the back of the neck. There was profuse bleeding from nostrils. His body was tied by a car seatbelt in semi prone position with flexed knees and elbows. Several knots were present, continued from the front of the neck through wrists, abdomen and ankles [Figure 1b].
At autopsy, postmortem hypostasis was found on the anterior aspect of the body due to semi prone position of the body. Early putrefactive changes like greenish discoloration over abdomen and marbling on the shoulder were found over body. Intense violaceous congestion was present on the face, neck, shoulders and chest. Mouth, lips, tongue were cyanosed, black in color. Horizontally placed three abrasions were present on the right and left side of chest and on the right abdomen of sizes 2.5 cm x 1 cm, 3.5 cm x 1 cm and 3 cm x 1 cm respectively. Multiple abrasions were present over front of both knees sizes ranging from 1-2.5 cm x 0.5-1.5 cm. Two black colored bruises of sizes 3 cm x 2 cm and 1 cm x 1 cm were present on the left side of the forehead with periorbital hematoma and right side of the face respectively. A ligature mark was present around the front, left and right side of the upper third of neck with knot mark underneath chin. The ligature mark was 13 cm in length transversely. It was 0.5-1 cm in breadth above downwards. The mark extended upward and backward and was faint on the back of the neck [Figure 2]. Three crescentic nail pressure abrasions were found over upper back sizes ranging from 1-2 cm x 1-2 cm.
On dissection, there was subcutaneous hemorrhage underneath the ligature mark in the neck muscle [Figure 3]. Airway and neck glands were congested. Hyoid bone and thyroid cartilage were intact. There were patchy hemorrhagic spots in the chest muscles over sternum and attaching with right and left costal margins [Figure 4]. Both lungs were highly congested with petechial hemorrhagic spots on the pleural and pericardial surface. The heart was 300 g in weight. Coronaries were calcified but not blocked. No intracranial hemorrhage or cranial fracture was noticed except scalp hematoma on the frontal area. All organs were congested. Histopathological examinations were mostly unremarkable except mild myocardial fibrosis. Toxicological tests were negative.
The cause of death was opined as asphyxia due to ligature strangulation associated with attempted plastic bag smothering and chest compression. However, blunt force head injury was considered as contributory cause but was not documented as fatal injury.
Crime scene visit and autopsy findings of the present case suggest the manner of death is homicide. The victim was incapacitated by inflicting blunt force forehead injury, tying the body by a car seat belt and wrapping a plastic bag around his face. Then he was strangled by the car seat belt tied around his neck, simultaneously his chest was compressed in prone position and mouth and nose were smothered by the plastic bag to death. The police investigation revealed that a stranger intruded into house and killed the elderly victim for the purpose of robbery.