A case of complex mechanical asphyxia due to physical restraint and gagging in an obese man

Death from positional asphyxia by physical restraint takes place when the abnormal position of the victim's body compromises the process of respiration. Dying in a supine restraint position is rare. The term ''gagging'' describes the blockage of the internal airways by ramming certain objects into the mouth. Here, we report the case of a 47-year-old obese man who had been kidnapped and was found dead in a supine position with limbs bound together in the back and the mouth gagged with stick. Apart from a very low level of the drug estazolam, and mild trauma on the body surface, autopsy findings were unremarkable. There were no injuries or pathological findings to account for his death. The cause of death was certified as mechanical asphyxia following gagging and restraint in a supine position. The victim's obesity is a co-factor in hastening his death.