An atypical disease-knowledge-related suicide by means of slashing the hemodialytic arteriovenous fistula

A case of suicide committed by self-cutting the arteriovenous fistula in a patient on hemodialysis is presented. A 77-year-old man was found dead with a blood-stained kitchen knife in the bedroom by his daughter. The man suffered from severe chronic renal failure, for which he needed hemodialysis. Moreover, he was recently diagnosed with bladder cancer relapse. At autopsy, there was a single incised wound on the anterior surface of the left forearm, which showed a regular slash of the skin and the subcutaneous tissues. After the dissection, there was a small-sized lesion affecting the arteriovenous fistula wall. Furthermore, faint postmortem lividity and diffuse visceral pallor were observed. Consequently, the cause of death was identified as an acute hemorrhagic shock after self-cut of the arteriovenous hemodialytic fistula. This case is worthy of several medicolegal considerations: firstly, autopsy examination should always be required in cases with atypical injuries, providing important data to differentiate suicides from homicides. Secondly, disease-knowledge-related suicides are an emerging phenomenon, which deserve careful analysis. Lastly, it is important to identify patients with chronic diseases for whom psychological support is needed, preventing suicidal ideation and reducing suicide risk.