Rectal wall hemorrhage in hanging autopsy cases

The aim of our study was to analyze hemorrhagic lesions of the rectal wall in hanging autopsy cases. All autopsy reports regarding hanging from January 1st, 2008 to December 31st, 2010 were retrospectively reviewed. One hundred and two hanging cases were selected out of 1379 autopsy cases. Rectal wall hemorrhage was found in about 4% of the cases (n = 4). Two of these 4 cases (50%) were associated with bowel wall hemorrhage, suggesting a similar possible etiology by abdominal congestion during the agonal phase. Another etiology could be an hemorrhagic lividity in the rectum. As it is not possible to determine with certainty the etiology, even with the use of histology, the detection of rectal wall hemorrhage cannot be used as another sign of vital hanging. Such rectum changes raise the possibility of sexual assault. Forensic pathologists should be aware of such an occurrence and avoid potential harmful misinterpretation.