Post-obstructive pulmonary edema following near-hanging: a case report and systematic review of published cases

Post-obstructive pulmonary edema (POPE) is a rare, life-threatening complication of strangulation. Management is based on low-grade evidence, and outcomes are poorly characterized.

To report a systematic review of POPE following near-hanging, illustrated by a case report that represents the first documented African case.

We combined a novel case report with a systematic review of published case reports and case series, conducted per a pre-registered protocol on the Open Science Framework (OSF). A clinical trial number was not applicable. A comprehensive search of major databases identified all relevant published cases. Data on demographics, management, and outcomes were extracted and synthesized descriptively.

Fifteen cases from 11 publications were included. Patients were predominantly young (median age 24). Symptoms overwhelmingly presented pre-hospital (93%). Glasgow Coma Scale (GCS) on admission was low (median 6), and the overall mortality rate was 40% (6/15). Adjunctive therapies were reported to be administered more frequently in survivors than in non-survivors, including diuretics (55.6% vs. 16.7%) and corticosteroids (44.4% vs. 16.7%), representing a potential clinical signal.

POPE following strangulation is associated with high mortality in young, otherwise healthy populations. This review identified a tentative association between adjunctive diuretic or corticosteroid therapy and improved survival. While these hypothesis-generating findings require cautious interpretation due to the low-level evidence, they represent a potential clinical signal necessitating further prospective evaluation and standardized reporting.