An uncommon combined methods of suicide. A case report

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Introduction Every one prefers a painless death, therefore, stabbing is not a preferred means of suicide. When multiple stabs on neck with several of them potentially fatal, it suggests homicide. It will be further complicated when such body is found inside a well. Case report A 26 year old married male was found floating face down in a well. There were no features of struggle at the scene. A table knife was also found inside the well. According to police, he was an accused of assaulting his wife. Acceding to an eyewitness, the deceased had jumped in to a well (figure 1). He had no previous attempts of suicide. At the autopsy, both conjunctivae were pale and there were more than 25 stab injuries on the front aspect of the neck (Figure 2). Most of them were superficial and parallel. Four injuries were deep and with bilateral internal jugular vein injuries. Both carotid arteries were spared. All organs were pale and there were flame shaped haemorrhages in left ventricle. There were no macroscopic or microscopic evidence suggestive of drowning. There were no defense injuries or injuries that cause incapacitation. Toxicological analysis was unremarkable. The cause of death was haemorrhagic shock due to stab injuries to the neck. P P 5 Discussion In the presence of two potential modes of deaths, namely neck stabs and drowning, it is important to ascertain the real cause of death. Though the body was recovered from a well, there were no macroscopic or microscopic evidence of drowning. Further, it was evident 2: stabs on the neck that four stabs were deep and had penetrated major vessels of the neck resulting massive haemorrhage leading to hemorrhagic shock with pale organs and flame haemorrhages in the heart. Therefore, the cause of deaths was ascertained as haemorrhagic shock due to multiple stabs to neck. The suicidal stab injuries are accompanied with hesitant stabs or cuts and are multiple, parallel and superficial. The weapon was found at the scene. The possibility of recent depression cannot be excluded due to the presence of strong evidence of marital problems and alleged wife battering. In addition, the presence of two suicidal methods; concomitant neck injuries and attempted suicide by drowning have turned out to be an important indication of suicide. Conclusion When ascertaining the manner, the possibility of multiple parallel stabs in homicides should also be considered. However, combination of two methods of suicides is a strong evidence as to the manner of death.