Ligature strangulations are usually homicidal. Accidental cases are quite uncommon, especially among adults. A retrospective ten-year study conducted in East Delhi revealed that in a total of 98 cases of death due to strangulation, five cases (approximately 5%) among all medico-legal deaths were of fatal ligature strangulation, involving adults who were neither intoxicated nor indulging in paraphiliac activity. The causative agent in three cases was a cycle rickshaw, in one case it was a rotatory part of a machine, and the fifth case occurred due to entanglement while tying up a cow. The cases and their autopsy findings have been described in this paper, together with the review and preventive aspects of such cases.