# Stab wound suicide mimicking homicide: a forensic case report

Mustapha Noun, Amine M Boumelik, Kada B Ayad, Imad Dine Bensefia, Shahrazed Benfarhate, Omar Hadjazi, Yassine Merad

## ► To cite this version:

Mustapha Noun, Amine M Boumelik, Kada B Ayad, Imad Dine Bensefia, Shahrazed Benfarhate, et al.. Stab wound suicide mimicking homicide: a forensic case report. 2025. hal-05038833

HAL Id: hal-05038833

https://hal.science/hal-05038833v1

Preprint submitted on 18 Apr 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
**Stab wound suicide mimicking homicide: a forensic case report**

Mustapha NOUN¹, Mohamed Amine BOUMELIK¹, Kada Bekhada AYAD¹, Imad Dine BENSEFIA¹, Shahrazed Benfarhate², Omar HADJAZI¹, Yassine MERAD³

¹Department of Forensic Medicine, Faculty of Medicine Taleb Morad, Djillali Liabes University, Sidi Bel Abbès, Algeria.

²Department of Diabetology and Endocrinology, Faculty of Medicine Taleb Morad, Djillali Liabes University, Sidi Bel Abbès, Algeria.

³Central Laboratory, Faculty of Medicine Taleb Morad, Djillali Liabes University, Sidi Bel Abbès, Algeria.

**Corresponding Author :**

Mohamed Amine Boumelik

Faculty of Medicine Taleb Morad, Djillali Liabes University, Sidi Bel Abbès, Algeria

Email: mohamed.boumelik@univ-sba.dz

Phone: +213 550 739 183

**Abstract**

**Introduction / Objective** : Suicide is a major public health concern, affecting all regions of the world and all age groups. While certain methods, such as hanging or firearms, are common and well-documented, others, like self-inflicted stab wounds, are rare and may closely mimic homicide, thus complicating the medicolegal analysis. The objective of this report is to present a rare case of suicide by stabbing, in which the initial findings strongly suggested a criminal act. **Methods** : A comprehensive forensic analysis was conducted, including the examination of the death scene, collection of statements from the victim's relatives, external examination of the body, and a full forensic autopsy. All findings were documented through judicial photography, and the objects found at the scene (including bloodstained knives) were collected, sealed, and analyzed. **Results** : A 27-year-old woman was found dead in the courtyard of her family home. The body presented multiple wounds located on the neck, chest, abdomen, and left wrist. Two bloodstained knives were discovered in close proximity to the body. The autopsy
revealed a fatal stab wound to the left ventricle of the heart, along with superficial
wounds consistent with hesitation marks. **Discussion / Conclusion**: This case
highlights the diagnostic complexity of suicides involving stab wounds, due to their rarity
and their potential resemblance to homicides. It underscores the importance of a
thorough and methodical forensic evaluation. Such cases, still underreported in the
literature, warrant further investigation to enhance medicolegal criteria for the accurate
identification of suicide.

**Keywords:** Suicide, Wounds, Stab, Autopsy, Forensic Medicine, Crime Scene Investigation.

Introduction

Suicide is a major public health issue (1), affecting all regions of the world and all age
groups. According to the World Health Organization, one person dies by suicide every
40 seconds worldwide (2).

While some suicide methods are common and well characterized, others—more atypical
or violent—can be misleading and may mimic criminal acts. In such complex cases, only
a thorough forensic evaluation, supported by the analysis of the death scene and
contextual data, can help guide the diagnosis.

Psychological autopsy studies have shown that over 90% of individuals who died by
suicide had a psychiatric disorder at the time of the act (3). These findings highlight the
importance of a multidisciplinary approach when analyzing unusual or atypical cases.
We report here a rare case of suicide by stab wounds, in which the initial findings
strongly suggested a homicide.

Case Presentation

We were called at 7:00 a.m. in January 2019 to attend a body removal involving a 27-year-old woman who was found deceased in the courtyard of the family home by her older brother.

Circumstances of Discovery
The victim's brother stated that he last saw his sister around 5:00 a.m., while she was preparing coffee in the kitchen. He then left to pray at the mosque and, upon returning around 6:45 a.m., found her lying in a pool of blood. The body removal was carried out in the presence of the Public Prosecutor and the forensic police unit.

## Scene Examination

The scene was a private residence consisting of three bedrooms, a kitchen, and a small courtyard. Examination of the premises revealed no signs of forced entry. The only access to the outside was the main entrance door, which was intact; all windows had been removed.

Outside, the body of the deceased was found lying on her back, fully clothed, with garments soaked in blood. Multiple fresh bloodstains and splatters were observed in close proximity to the body. No traces of blood were found elsewhere in the house. Two bloodstained knives were discovered next to the body. They were photographed, sealed in Kraft paper bags, and collected for analysis.

## Forensic Findings at the Scene

External examination of the body revealed a warm corpse with early rigor mortis affecting the face and upper limbs. Dorsal livor mortis was present, suggesting that death had occurred less than three hours prior. The position of the body, its posture, and the layout of the scene were documented by the forensic photographer.

## Forensic Autopsy

The body was transported to the Department of Forensic Medicine at the University Hospital Center of Sidi Bel Abbès (Algeria) for a judicial autopsy. External examination revealed a woman in good postmortem preservation, presenting multiple wounds on the anterior surface of the body:

**Neck:** multiple anterior cervical wounds, horizontal and parallel, caused by a sharp-edged weapon. They begin high on the left side of the neck and become progressively more superficial toward the right. Several small superficial wounds are visible at the starting point of the incisions.
Left wrist: two initially superficial wounds that become deeper toward the end. No signs of defensive injuries were observed on the fingers, hands, or forearms.

Torso: six deep wounds located on the left breast, arranged in a horizontal pattern (Figure 1).

Abdomen: three superficial periumbilical wounds, each measuring 2 cm in length, caused by a sharp or pointed instrument (Figure 2).

The autopsy concluded that death was caused by hemorrhagic shock resulting from a stab wound to the left ventricle of the heart. The other wounds were superficial. No signs of prior self-harm were identified. No injuries suggestive of restraint, struggle, or defensive actions were observed.

# Discussion

## General Considerations and Risk Factors

Suicide remains a current and pressing public health issue. Risk factors are numerous and include psychiatric and somatic conditions (4,5), sociodemographic and socioeconomic factors, as well as environmental influences (6,7).

Suicide by stabbing is an uncommon method. In all cases of death involving this mechanism, the possibility of a criminal circumstance must be carefully considered.

## Forensic Analysis of the Injuries

In our case, where multiple stab wounds were found on the body, the diagnosis of suicide was primarily based on the scene investigation and, most importantly, on the forensic analysis of the injuries.

At the cervical level, several superficial transverse incisions were observed, beginning on the left side and crossing the neck obliquely toward the right, ending in a "rat-tail" shape, a feature typically associated with suicidal gestures. The wound was deeper on the left side than on the right, further supporting the hypothesis of self-infliction.

So-called "tentative," "hesitation," or "trial" wounds were present at the beginning of the cervical incisions. These superficial, parallel wounds located near the primary lesion are classically described in suicidal acts (8).
At the thoracic level, the clustered nature of the wounds, their accessibility, and their horizontal orientation are additional arguments in favor of suicide. The location of the injuries on the left side of the chest is consistent with the literature, which identifies this region as a common site for self-inflicted wounds in suicide cases.

The multiplicity of wounds and the diversity of their locations are sometimes observed in suicide cases, as illustrated by the study of B. Krager et al. (9), which reports the case of a man who inflicted 92 stab wounds on himself, with injuries to the forehead, neck, chest, and skull.

On the left wrist, two wounds were observed—initially superficial, then deeper—consistent with self-inflicted injuries, in accordance with the observations reported by Kim J. et al. (10).

The autopsy revealed no defensive injuries on the hands, fingers, forearms, or back. This absence is a key element supporting the hypothesis of a self-inflicted act.

## Scene Analysis: Weapons, Clothing, and Comparative Data

The discovery of bladed weapons near the body and the absence of significant tears in the clothing support the hypothesis of suicide. However, the presence of cuts in the clothing does not necessarily indicate homicide. T. Ohshima et al. (11) reported five cases of suicide with clothing perforations out of a total of eight cases.

## Diagnostic Challenges and Forensic Contribution

Although suicides by stabbing are rare among suicide cases, they present a particular diagnostic challenge. The distinction between homicide and suicide, especially in the presence of multiple wounds in different anatomical locations, cannot be based solely on the examination of the body. It is the rigorous comparison of scene findings, investigative results, and the detailed forensic analysis of the injuries that allows for a conclusive determination of suicide.

## Conclusion

This case illustrates the diagnostic challenges posed by atypical forms of suicide, particularly those involving sharp-edged weapons. The initially suspicious nature of the
scene, the multiplicity and distribution of the injuries, as well as the absence of direct witnesses, initially raised the possibility of a criminal act. However, the convergence of forensic elements—such as the absence of defensive wounds, the presence of hesitation marks, the accessible topography of the injuries, the discovery of weapons near the body, and the intact exits of the house, led to the conclusion of a self-inflicted act.

This case highlights the importance of a thorough forensic approach, combining scene analysis, psychosocial context, and injury assessment to distinguish suicide from homicide. It also serves as a reminder that, despite their rarity, suicides by stabbing do occur and must be carefully considered without rushing to a premature diagnosis.

Such cases deserve greater documentation in the scientific literature in order to enrich interpretative criteria and help practitioners avoid diagnostic errors.

## Ethical Considerations

This study was conducted in accordance with the ethical standards of the Hassani Abdelkader University Hospital Center (Sidi Bel Abbès, Algeria). Informed consent was obtained from the patient's legal representative for the publication of the case details.

## Conflict of Interest

The authors declare that they have no conflict of interest.

## Funding Sources

The authors received no financial support for the research, authorship, or publication of this article.

## Références

1. Amini S, Bagheri P, Moradinazar M, Basiri M, Alimehr M, Ramazani Y. Epidemiological status of suicide in the Middle East and North Africa countries (MENA) from 1990 to 2017. Clinical Epidemiology and Global Health. 1 janv 2021;9:299-303.

2. Preventing suicide: A global imperative [Internet]. [cité 30 mars 2025]. Disponible sur: https://www.who.int/publications/i/item/9789241564779

3. Moeurs, morale et droit chez Durkheim - ProQuest [Internet]. [cité 30 mars 2025]. Disponible sur:
https://www.proquest.com/openview/3dbfcdc0afe3a24b8ce2092c90737c91/1?cbl=1817466&pq-origsite=gscholar

4. Plancke L, Coton C, Amariei A, Danel T, Charrel CL. Le décès par suicide de personnes souffrant de troubles mentaux. Revue d'Epidémiologie et de Santé Publique. 2020;68(Supplément 1):S31-2.

5. Patoz MC, Samalin L. Comprendre les conduites suicidaires: définition et facteurs de risque. La Presse Médicale Formation. 2022;3(4):316-21.

6. Le Clainche C, Courtet P. Facteurs de risque de suicide et de vulnérabilité au suicide. Suicide Connaître pour prévenir: dimensions nationales, locales et associatives 2e rapport. 2016;115-53.

7. Räsänen P, Hakko H, Jokelainen J, Tiihonen J. Seasonal variation in specific methods of suicide: a national register study of 20 234 Finnish people. Journal of Affective Disorders. 2002;71(1-3):51-9.

8. Patil SS, Deokar RB, Vidhate SG, Tyagi S. An atypical case of suicidal cut throat injury. Egyptian Journal of Forensic Sciences. 2016;6(4):492-5.

9. Karger B, Vennemann B. Suicide by more than 90 stab wounds including perforation of the skull. International Journal of Legal Medicine. 1 déc 2001;115(3):167-9.

10. Kim JH, Yoo H, Eun S. A pilot study of 17 wrist-cutting suicide injuries in single institution: perspectives from a hand surgeon. BMC Emerg Med. déc 2021;21(1):40.

11. Ohshima T, Kondo T. Eight cases of suicide by self-cutting or-stabbing: consideration from medico-legal viewpoints of differentiation between suicide and homicide. Journal of clinical forensic medicine. 1997;4(3):127-32.
**Figure 1:** Deep wounds on the left breast, arranged in a horizontal pattern, caused by a sharp or pointed instrument.

<figure><img src="image_2.png" /></figure>

**Figure 2:** Superficial periumbilical wounds, each measuring 2 cm, caused by a sharp or pointed instrument.

<figure><img src="image_3.png" /></figure>