Men’s Suicide by Self-abdominal Cut and Disembowelment: A Literature Review and Analysis of Three Cases

Abstract

Introduction: Suicide by abdominal cut wounds and consequent disembowelment is a modality rarely described in the literature, with rates between 1.6% and 3%. The incidence is higher in men. This type of suicide might be so unusual as the abdominal injuries are not supposed to be related to immediate death (compared to the wrists or throat, which involves rapid bleeding, for example). Considering the infrequency of suicides by abdominal self-cutting, in such cases, the main hypothesis is a homicide, especially in those with multiple injuries or occurred in a complex setting. These cases require a detailed autopsy report with the analysis of the injuries and circumstances of death (e.g., farewell note, history of depression, previous suicide attempts, defense injuries, and signs of hesitation) to allow a differential diagnosis between suicide and homicide. This study aims to highlight the characteristics of suicides through self-cut wounding, focusing on those that determine a large abdominal opening and evisceration. Methods: The authors conducted the literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, on PubMed and Scopus databases, using the following keywords: "(suicide) AND (abdominal stab wounds)", "(suicide) AND (abdominal sharp injuries)", "(suicide) AND (abdominal self-stabbing)", "(suicide) AND (abdominal cut wounds)". Results: 7 articles were included in the systematic review, for a total of 11 cases of suicide by abdominal self-cutting. Of these cases, 3 were women and 8 were men. Conclusions: The analysis of the external examination findings versus the crime scene results is essential to clarify if injuries are self-inflicted with suicidal intention. Suicide through a violent act can also be practiced by people who have no history of psychiatric conditions or other risk factors. Therefore, in cases of abdominal cut and evisceration with victims' survival time, the forensic pathologist has to consider that the deceased himself could cause modifications to the crime scene, turning it into a complicated suicide.