Medical suicide -- groin stabbing

This case report concerns a 50-year-old male who died from exsanguination due to self-inflicted stabbing injuries to the groin and cutting injuries to the neck. He was a medical doctor suffering from depression following treatment for cancer. Postmortem examination revealed that stab injuries in the groin were directly over the femoral arteries where the femoral pulse is clinically palpated. The injury pattern of this suicidal stabbing is uncommon and the medical knowledge of this person may have well contributed to the choice of the site.     

A case of suicide-by-cop

A young man was shot dead on the street by police officers. The results of the investigation indicated that the use of firearms had been provoked with suicidal intent by the victim. A 25 year old man intruded with his car into a row of six police vehicles that was in the midst of an operation. Upon stopping at a traffic light he left his vehicle and pulled out a weapon which was later determined to have been a blank cartridge pistol. He took aim at the officers in the following vehicle from a distance of not more than 2 m. Despite repeated orders to put down the weapon, the man did not comply. Thus, as a result of the presumed threatening situation in which four officers were involved, several shots fell that were fatal for the individual. In the postmortem examination the cause of death was determined to be haemorrhagic shock due to penetration of the aorta by a projectile. On the basis of the results of the investigation a particular form of suicide was presumed since a depressive disorder in some form had been present. The man had expressed suicidal thoughts several times and had taken conspicuous leave of his wife on the day of the incident.     

A curious autopsy case of a car crash in which self-strangulation and lung collapse were found: a case report

A curious autopsy case following the car crash of a 20-year-old male, in which self-strangulation and lung collapse were observed, is presented. His motor vehicle had crashed into a restaurant as a result of self-strangulation using an electrical cord wound four times around his neck. At autopsy, we found small rupture holes of spontaneous bullae in both lung apices, which had probably taken place upon collision during driving, petechial hemorrhages in the face skin and the absence of severe injuries. Since it seemed unlikely that the small holes in both lung apices caused fatal pneumothorax instantly, the cause of his death was judged to be asphyxia due to self-strangulation. It is not clear whether the self-strangulation was suicidal or autoerotic, because neither traces of suicidal intent nor circumstances suggesting either of them were disclosed.     

Intracranial penetrating injury by screw driver: A case report and review of literature

Penetrating injury to the head, with the exception of missile injuries is rare owing to thick calvarium. Orbital and temporal areas are comparatively vulnerable to penetrating injuries, due to their relative thinness. A case is presented in which a man killed his wife by forcefully thrusting a screw driver into her cranial cavity. The deceased presented to the hospital with the screw driver embedded in her head. She was declared as ‘brought dead on arrival’ at the emergency of the hospital. Pre-autopsy plain radiography and Computed Tomography (CT) of the head were done to assess the extent of brain damage. The peculiarity of this case lies in the fact that screw driver as a stabbing weapon in the head is very rarely used. In such cases, there is a need to perform radiography and CT with the weapon in-situ for better interpretation on injuries. In this paper role of radiography and CT in intra cranial penetration is discussed with review of literature.     

Delayed deaths after vascular traumatism: two cases

During expert testimony in court, forensic pathologists are often asked to estimate the length of survival following fatal injuries. Though it is impossible to be precise, fatal vascular trauma survival times are generally considered short. We here report two unusual cases of delayed deaths, one following homicidal stabbing of the heart and the other by suicidal cutting of the neck. In those two cases, investigation clearly provided evidence of prolonged survival: slightly more than 2h for the first case and about 8h for the second. Relevant literature is revised and physiopathological hypotheses are discussed.     

Crossbow injuries: A case of suicide

We are reporting the case of a 65 year-old man who suffered a severe depression and committed suicide using a crossbow. The death happened at his home. The suicide victim was on his knees, with of a crossbow leveled at his thorax and located facing him on the sofa. He shot it by pulling the trigger with the bended end of a ramrod. The arrow entered between the third and the fourth rib on the left side, with a downwards and slightly outwards direction. It went through the lung and the tip of the arrow came out the back.The arrow was removed when the body was lifted, and the wounds had a three-pointed star shape which corresponded to the head of the arrow crossbow. Police enquiry and forensic investigation confirmed a suicidal manner of death.This paper presents different issues of the case, such as the attestation of tears in clothing, the morphology of the wounds or the arrow track. The case is compared with other cases in the medical forensic literature involving the use of crossbows. Finally, it is highlighted how easy it is to purchase these weapons despite their obvious power and accuracy, factors that seriously recommend legislative regulation to be increased and its use more restricted.     

An unusual case of suicidal carbon monoxide poisoning

The authors present a case of suicide by carbon monoxide poisoning in a confined space with interesting elements related to the method and the circumstances in which it took place. Carbon monoxide poisoning is a very common cause of death in accidental and suicidal cases, but the method used in this case, consisting of burning charcoal in a small office bathroom, presents some particularly interesting aspects. The circumstances, moreover, appear very interesting because the person who committed suicide was an employee of the Public Administration and he had received notification regarding his involvement in a legal prosecution.     

Sudden death due to massive hemoptysis secondary to pulmonary tuberculosis – A case report

Forensic pathologists deal not only with criminal, accidental and suicidal deaths, but also with a wide range of deaths from natural causes. Natural deaths at times can be sudden, unexpected and unattended by the relatives or friends or eye witnesses. In such cases, even though there is no criminal element in their causation, the case has to be investigated and medico-legal autopsy has to be conducted to know the exact cause of death, thus putting an end to the allegations raised. A 55-year-old male was found dead lying in his room in a pool of blood without any obvious injuries under suspicious circumstances with disturbed furniture in his room. The case was investigated due to suspicious circumstances of his death and absence of history of significant medical illness. The autopsy revealed the death was due to asphyxiation as a result of massive hemoptysis secondary to fibro-cavitatory tuberculosis.     

A case of self amputation of penis by cannabis induced psychosis

Self-mutilation, self-injuring or self-harming behaviour has been defined as deliberate destruction or alteration of body tissue in the absence of conscious suicidal intention. Persons suffering from mental disorder may inflict hundred of small wounds upon themselves which may be added to the actual cause of death. Another recognized syndrome is self mutilation of genitals almost invariably in males suffering from paranoid schizophrenia and often with strong religious flavour to their delusion. Here we present a case of a 35-year-old male who self mutilated his penis due to dependence on cannabis for the past few years that led to a condition called cannabis induced psychosis.     

Deaths caused by mole guns: three case reports

Possession of firearms is limited because of the technological requirements in production and strict laws. However, anyone can manufacture a handmade firearm by following simple instructions and has no legal liability. A mole gun is an unusual weapon used to kill moles in agricultural areas. It propels pellets in a similar way as a shotgun. This study presents three cases of death caused by mole guns. Two of the cases were accidental, and the other case was suicidal. The first case involved a 51-year-old man who was checking the mole gun when it fired, injuring his left eye and the left region of his face. He died in the hospital after 3 days of medical treatment. The second case was a 78-year-old man, who had been intermittently treated for depression over the last 15 years. He died instantly after placing the mole gun vertically against his head and firing it. The third case was a 43-year-old man who had been trying to set up a mole gun device in his potato field when the weapon accidentally discharged. The victim was injured seriously and died in the hospital a short time later. In conclusion, because the mole gun may cause lethal wounds in humans when fired from a short distance, the researchers believe that its production and use should be in accordance with firearms laws.     

Heart disease vis-à-vis trauma

Virtually all forensic experts deal not only with criminal, suspicious, accidental and suicidal deaths, but are also confronted with a wide range of deaths where a significant natural element is revealed at autopsy. The assaulted victim that dies suddenly or unexpectedly from a stroke during or immediately succeeding the receipt of some non-fatal injuries, or otherwise suffers a clinically unexplained death, can pose far greater difficulties over causation than a gun-shot or a stabbing. This paper presents an analysis of the problem and an approach for determining the cause of death in cases of concurrent trauma with heart disease, and in cases with a substantial natural element of disease but exclusion of trauma. Relevant cases with history, autopsy findings, histopathological findings and toxicological findings are presented in order to illustrate the issue from a practical angle.     

Suicidal hanging resulting in complete decapitation: a case report

This paper reports the case of a 22-year-old man, weighing 87.5 kg, who committed suicide by jumping from a bridge over a canal with a nylon rope tied around his neck. The drop height was between 3.70 and 5.30 m before the rope tightened and the subject was completely beheaded. The head sank straight under the bridge, while the torso floated 205 m downstream. Pertinent autopsy findings were a sharp decapitation wound with circumferential skin abrasion and cervical spin transection between C1 and C2. Decapitation is a complication of extreme rarity in the event of a suicidal hanging and is always related to a drop of several metres with a poorly extensible line used as the hanging ligature.     

Suicide by more than 90 stab wounds including perforation of the skull

A man committed suicide in his bathroom using a small pocket knife. At the autopsy a total of 92 stab wounds on the forehead, in both temples, the anterior aspect of the neck, the back of the neck, the chest and the sides of the trunk were found. In addition, repeated stabbing had caused a large soft tissue defect on the forehead. The frontal bone showed 3 perforations but no brain injury was present and two ribs were severed in the bony part, one of which carried a star-like pattern from repeated stabbing. No major vessels were injured and the cause of death was exsanguination after a considerable survival time. The large number of stab wounds, the perforation of bone and some injury sites, especially the head and back of the neck, are extraordinary findings in suicides which were probably favoured by insufficient anatomical knowledge and the use of a short-bladed knife. A psychiatric history could not be verified. Received: 15 May 2001 / Accepted: 9 June 2001     

Self-inflicted explosive death by intra-oral detonation of a firecracker: a case report

Self-inflicted explosive deaths due to detonation of fireworks are rare. In this case report, a peculiar case of an elderly male who discharged a firecracker inside his mouth, resulting in fatal blast induced craniofacial injuries, is described. There is paucity of published data describing fireworks-related suicidal and/or non-suicidal deaths. Even scantier data is present specifically describing fireworks-related blast induced neurotrauma and the mechanism(s) of injury involved in such cases. This case report emphasizes the severe damage that a commercially available explosive, the so-called “Gorilla Bomb”, can cause, and raises questions about the relative ease of its acquisition.     

Suicide,depression and thyroid dysregulation: An unusual case of unplanned complex suicide

Complex suicides are rare events pursued by the victims by means of two or more different fatal methods and can be further classified in planned or unplanned depending on the simultaneous or sequential application of the methods, respectively. The multiplicity of the injuries detected can frequently lead to misinterpretations, thus making a multidisciplinary approach of utmost importance. Here an unusual unplanned complex suicide was described discussing the post-mortem data leading to the forensic diagnosis; moreover, a focus on the depression cause was reported. The case regarded a 48-year-old man with a recent diagnosis of depression who self-stabbed his neck and, subsequentially, fallen from height. Data obtained from autopsy, histology, radiology and toxicology were described, highlighting the main findings for achieving the differential diagnosis between suicide and homicide. Moreover, microscopic findings compatible with an unrecognized thyroiditis led to consider the thyroid dysfunction as a possible substrate of depression, suggesting it potential effect on suicidal behaviour.     

Suicidal choking caused by a bizarre combination of inhalation to the bronchi and external neck compression

We report a remarkable case of suicidal choking in an elderly man with depressive episodes and one previous attempt of suicide. Initially, the presence of a sweater around his neck and blunt injuries on his head, left elbow and sacrum region seemed to indicate a suspicious violent death. During the necropsy study, a fragment of newspaper was discovered inside his lower respiratory tract. Autopsy findings showed minimal punctata haemorrhages on the larynx and trachea. The subsequent toxicological investigation was negative. This case is extremely rare, because the deceased was not a schizophrenic patient and the peculiar foreign object was found in the lower level. To the best of our knowledge, in medicolegal literature, few similar cases have been reported.     

An autopsy case of a charred body which committed suicide after arson

A severely burned body was found lying on its right side at the scene of the fire in a 2-story wooden apartment house. The presence of a ligature (an electrical cord) running horizontally around the neck aroused suspicion of arson after homicidal strangulation (murder-arson). The entire body was severely burned and partly charred. The head and neck were severely charred, and the left temporal bone had been consumed exposing the brain. Around the neck was looped an electrical cord, which ran horizontally and canted downward toward the nape, leaving a furrow resulting from the knot being tightened up. No other injuries or pathologic lesions suggestive of the cause of death were noted. No drug, poison or alcohol was detectable in the blood or urine. The peculiar method of making a noose of the ligature around the neck is called clove hitch, which makes the noose tighten further with increased load. The fallen curtain rod had a bend with an acute angle, which was considered to have been the point of suspension in hanging. In addition, a lighter was found under the corpse, which was presumably used to ignite the gasoline that the deceased sprinkled. We speculate, therefore, that the deceased hanged himself by placing the electrical cord around his neck (by clove hitch), suspending it from the curtain rod, sprinkling gasoline in his room, igniting it with a lighter, executing suicidal hanging after the start of the fire. Probably the body was wrapped in flames while dangling, then fell to the floor together with the collapsing curtain rod.     

A new challenge in forensic toxicology exemplified by a case of murder under the influence of a synthetic cannabinoid – AM-2201

Among new psychoactive substances (NPS) available on the narcotic market, a significant number consists of synthetic cannabinoids commonly known as smokable herbal “spice” and “K2”, and which are legally treated as a legal alternative to marijuana. The dearth of information on the pharmacology of these intoxicants as they are introduced into the market has created the urgent need among healthcare providers for case studies on the substances belonging to this group, both in terms of the consequences of using such intoxicants, and in methods of detection. The subject of the present report is a multi-parameter analysis of a criminal case of an 18-year-old male who was charged with murder of his female relative and attempted murder of two other victims by stabbing. The defendant pleaded guilty, but he claimed that he had been acting without volition, because he was under the influence of the synthetic cannabinoid AM-2201, which had been purchased from a dealer as a 10 g package labelled “Mr Green – No bad trip”. Analytical methods including gas chromatography – electron ionization – quadrupole ion trap mass spectrometry (GC-EI-QIT/MS) and liquid chromatography, electrospray ionization, tandem mass spectrometry (LC-ESI-MS-MS) were developed to determine the presence of AM-2201 in the Mr Green – No Bad Trip, and in the blood of the perpetrator, respectively. Toxicological findings are discussed in the context of psychoactive and adverse physical effects resulting from the presence of AM-2201 in the human body; the observations were also analyzed in conjunction with data from the literature.     

Ochronosis--an autopsy case report

The authors have presented a case of ochronosis, as the incidental finding during the autopsy of a female patient, aged 59 years. It was the case of suicidal drug poisoning. Ochronosis is a rare disease, with chronic benign course, but frequently followed by complications. Histopathological criteria for the diagnosis of this disease are described in detail.