Background: Differentiating between homicide and suicide can be difficult and even impossible. In this report, we presented a fatal stabbing injury, which made a challenge in the verification of the manner of death.
Case Report: A 45-year-old man was found dead in his workplace with a knife beside him. His mouth was closed with a scarf, his clothes were intact, and no evidence of a struggle was observed in the scene investigation. There was a vertical stab wound on the midline of the victim’s belly and his intestines were tangled out of the wound. In the autopsy, no defense wound was found. There was blood in the abdominal cavity and retroperitoneal region and several perforations were observed in the intestine and liver along the superficial wound. Painful death and torturous extraction of visceral organs resembled homicide, but nothing indicative of hostility and homicide was found by the forensic exploration and police investigation. Finally, the manner of death was assigned as suicide and the cause of death was a hemorrhagic shock as a result of sharp force injuries.
Conclusion: This case represents a bizarre suicide, which is rare and highly suspicious of homicide. In such mysterious cases, the evidence of autopsy and crime scene and police investigation should be regarded to make a decision.
Malakouti SK, Davoudi F, Khalid S, Asl MA, Khan MM, Alirezaei N, et al. The epidemiology of suicide behaviors among the countries of the eastern Mediterranean region of WHO: A systematic review. Acta Medica Iranica. 2015; 53(5):257-65.
Lau M, Wu JH. Complex suicide or concealed homicide? The case of multiple stab wounds in a fatal fall from a height. Pathology. 2019; 51:S116. [DOI:10.1016/j.pathol.2018.12.330]
De‐Giorgio F, Lodise M, Quaranta G, Spagnolo AG, d’Aloja E, Pascali VL, et al. Suicidal or homicidal sharp force injuries? A review and critical analysis of the heterogeneity in the forensic literature. Journal of forensic sciences. 2015; 60:S97-107. [DOI:10.1111/1556-4029.12673] [PMID]
Karlsson T. Homicidal and suicidal sharp force fatalities in Stockholm, Sweden: Orientation of entrance wounds in stabs gives information in the classification. Forensic Science International. 1998; 93(1):21-32. [DOI:10.1016/S0379-0738(98)00025-5]
Karger B, Niemeyer J, Brinkmann B. Suicides by sharp force: Typical and atypical features. International Journal of Legal Medicine. 2000; 113(5):259-62. [DOI:10.1007/s004149900093] [PMID]
Singh KP, Keisham S, Rishilu K, Devi TM. Suicidal death due to stabbing: A case of rare occurrence. Journal of Indian Academy of Forensic Medicine. 2014; 36(4):434-6.
Ohshima T, Kondo T. Eight cases of suicide by self-cutting or-stabbing: Consideration from medico-legal viewpoints of differentiation between suicide and homicide. Journal of Clinical Forensic Medicine. 1997; 4(3):127-32. [DOI:10.1016/S1353-1131(97)90092-4]
Fukube S, Hayashi T, Ishida Y, Kamon H, Kawaguchi M, Kimura A, et al. Retrospective study on suicidal cases by sharp force injuries. Journal of Forensic and Legal Medicine. 2008; 15(3):163-7. [DOI:10.1016/j.jflm.2007.08.006] [PMID]
Byard RW, Klitte Å, Gilbert JD, James RA. Clinicopathologic features of fatal self-inflicted incised and stab wounds: A 20-year study. The American Journal of Forensic Medicine and Pathology. 2002; 23(1):15-8. [DOI:10.1097/00000433-200203000-00003] [PMID]
Atreya A, Rijal D, Kanchan T, Shekhawat RS. Abdominal self-stabbing: A case report. Medico-Legal Journal. 2017; 85(2):97-9. [DOI:10.1177/0025817216683583] [PMID]
Pelletti G, Visentin S, Rago C, Cecchetto G, Montisci M. Alteration of the death scene after self-stabbing: A case of sharp force suicide disguised by the victim as a homicide? Journal Forensic Sciences. 2017; 62(5):1395-8. [DOI:10.1111/1556-4029.13440] [PMID]