Tracheal perforation from non-fatal manual strangulation

Non-fatal strangulation is a very common but often underestimated cause of severe injury. In this case, a woman experienced several episodes of manual strangulation in an episode of domestic violence which involved loss of consciousness, confusion and neck pain, particularly over the trachea. CT angiogram of the neck showed a small perforation of the trachea at the level of the thoracic inlet. The prevalence of non-fatal strangulation in the Australian general population is unknown, but a study in Western Australia measured a prevalence of 7.4% of women presenting to a sexual assault service. A systematic review analysing data from 9 countries in North America and Europe, estimated a lifetime prevalence by an intimate partner of between 3.0% and 9.7% of all women (1). US data suggests that of those experiencing intimate partner violence, prevalence ranges from 27 to 68% (2, 3). This article considers the limited science known about the injuries sustained from non-fatal manual strangulation, much of which is extrapolated from case reports in the literature.