Complex suicides: A review of the literature with considerations on a single case of abdominal self stabbing and plastic bag suffocation

Complex suicides are rare and consist in the use of more than one method to induce death, representing a challenging investigation for forensic pathologists. According to the several combinations reported in literature, they have been classified into “typical” (where two common suicide methods are associated) and “atypical” (where more than two methods, or infrequent combinations of suicide methods are involved). In the case discussed here, an elderly man suffering of depression was found dead inside the tool shed of his house with a knife embedded in the abdomen and two plastic bags fastened around the neck using a twine. Three other superficial stab wounds were clustered close to the penetrating lesion. Internal examination revealed haemorrhagic infiltration at the mesentery and haemoperitoneum. No evident signs of asphyxia were highlighted and the cause of death was attributed to haemorrhagic shock. This association of suicide methods has turned out to be unusual. A review of the literature concerning complex suicides, abdominal self-stabbing and plastic bag suffocation has been managed. Crime scene and details of the used tools, medical and psychiatric history of the victim and features of the internal and external lesions have been examined and compared to previous studies. Toxicological analyses were not performed.