Two case-reports of unusual complex suicide

BACKGROUND : Suicide cases usually report a unique kind of lesion: either stab injuries, or gunshot lesions, or hanging, or poisoning, or precipitation and so forth. Sometimes, suicide victims perform a strange complex ritual involving several different self-inflicted lesions, to reach their purpose. Since the beginning of 2012, two very peculiar cases have come to the attention of the Institute of Legal Medicine in Milan. CASE 1: a 36-years-old transexual women was found dead in her home, with a knife stuck in the thorax and another stab injury beside the previous one. A pajama sleeve was tied tightly around the neck and the gas stove was open. At autopsy, the neck groove was depressed but there was no evidence of excoriation; both thyroid horns were fractured, with blood infiltration. Stabbing injuries involved the left lung, diaphragm, stomach and spleen. Toxicological analysis showed a small amount of alcohol (0.29 g/l) in the blood and the presence of benzodiazepines in blood and urine. Instead, the presence of carbon monoxid in cardiac blood was very low (2,7%).In the gastric content there were chemicals such as methylpalmitoleate, ammonium laurate and so on, normally used in detergents, which she had presumably swallowed. CASE 2: The latter concerns a 49-year-old woman, who jumped from the sixth floor and was found dead on the sidewalk beside her house. Law enforcement officers found in her flat a farewell letter; a plastic chair on a table in the terrace, probably used to climb over the wall and reach the roof; an almost empty plastic bottle containing sodium hydroxide, and a kitchen knife on the roof. At autopsy the presence of multiple stab injuries in neck, chest and abdomen were found, causing a lesion to the jugular vein. The stomach contained 500ml of a brownish-blackfowl-smelling liquid, conditioning the presence of a blackish mucosal surface and a hypertrophic plicature. However the cause of death were the multiple skeletal and visceral lesions due to the contusive mechanism of the fall. CONCLUSION: Literature contains many case-reports of complex suicides: they account for 1,5-5% of all suicides. In most cases a double-modality of combined suicides is described; three-modality ones are more rarely observed. We report a four-modality-combined suicide (described only once in literature), in which there is more than one deep stab wounds: even cases of multiple stab wounds in suicides are reported few times in literature