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Open Access Special Issue

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

  • Stefania De Simone1
  • Simona Vittorio1
  • Luigi Cipolloni1,*,
  • Roberta Bibbò1
  • Giovanni Gurgoglione1
  • Nicola Di Fazio2
  • Maria Antonella Bosco1

1Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy

2Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy

DOI: 10.31083/j.jomh1807158 Vol.18,Issue 7,July 2022 pp.1-7

Published: 31 July 2022

*Corresponding Author(s): Luigi Cipolloni E-mail:


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.


sharp abdominal wounds; suicide; disembowelment; stab abdominal wounds; cut abdominal wounds; crime scene investigation;

autopsy; self-cut suicide; suicidal behaviour; homicide

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Stefania De Simone,Simona Vittorio,Luigi Cipolloni,Roberta Bibbò,Giovanni Gurgoglione,Nicola Di Fazio,Maria Antonella Bosco. Men’s Suicide by Self-abdominal Cut and Disembowelment: A Literature Review and Analysis of Three Cases. Journal of Men's Health. 2022. 18(7);1-7.


[1] Karačić A, Vojvodić B. Abdominal Self-Stabbing: an Uncom-mon Type of Sharp Abdominal Trauma. Case Reports in Emer-gency Medicine. 2021; 2021: 1–3.

[2] Plackett TP, Fleurat J, Putty B, Demetriades D, Plurad D. Se-lective Nonoperative Management of Anterior Abdominal Stab Wounds: 1992–2008. The Journal of Trauma. 2011; 70: 408–414.

[3] Byard RW, Klitte A, Gilbert JD, James RA. Clinicopathologic Features of Fatal Self-Inflicted Incised and Stab Wounds: A 20- year study. The American Journal of Forensic Medicine and Pathology. 2002; 23: 15–18.

[4] Bukur M, Inaba K, Barmparas G, DuBose JJ, Lam L, Branco BC, et al. Self-inflicted penetrating injuries at a Level i Trauma Center. Injury. 2011; 42: 474–477.

[5] Karger B, Vennemann B. Suicide by more than 90 stab wounds including perforation of the skull. International Journal of Legal Medicine. 2001; 115: 167–169.

[6] Assunção LA, Santos A, Magalhães T. Suicide by sharp force injuries – A study in Oporto. Legal Medicine. 2009; 11: S216–S219.

[7] Peyron P, Casper T, Mathieu O, Musizzano Y, Baccino E. Com-plex Suicide by Self‐stabbing and Drowning: A Case Report and a Review of Literature. Journal of Forensic Sciences. 2018; 63: 598–601.

[8] Riviello RJ. Manual of forensic emergency medicine: a guide for clinicians. Jones and Bartlett Publishers: Sudbury, Mass. 2010.

[9] Takai M, Yamamoto K, Iwamitsu Y, Miyaji S, Yamamoto H, Tatematsu S, et al. Exploration of factors related to hara-kiri as a method of suicide and suicidal behavior. European Psychiatry. 2010; 25: 409–413.

[10] Becker A, Peleg K, Dubose J, Daskal Y, Givon A, Kessel B. Abdominal stab wound injury in children: do we need a different approach? Journal of Pediatric Surgery. 2019; 54: 780–782.

[11] Venara A, Jousset N, Airagnes G, Arnaud J, Rougé-Maillart C. Abdominal stab wounds: self-inflicted wounds versus assault wounds. Journal of Forensic and Legal Medicine. 2013; 20: 270–273.

[12] Krywanczyk A, Shapiro S. A Retrospective Study of Blade Wound Characteristics in Suicide and Homicide. The American Journal of Forensic Medicine and Pathology. 2015; 36: 305–310.

[13] Kranioti EF, Kastanaki AE, Nathena D, Papadomanolakis A. Suicidal self-stabbing: a report of 12 cases from Crete, Greece. Medicine, Science, and the Law. 2017; 57: 124–129.

[14] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. British Medical Jour-nal. 2021; 372: n71.

[15] Mugadlimath AB, Sane MR, Zine KU, Hiremath RM. Suicide by self-disembowelment in prison. Amsik. 2018; 68: 171–178.

[16] Judea-Pusta C, Rusu A, Camarasan A. Suicide by abdominal wounds suggesting seppuku: Case reports from Romania and an international literature review. Aggression and Violent Be-havior. 2019; 47: 68–73.

[17] Shakya A, Ranjitkar M, Pandey S. An Atypical Self-Inflicted Abdominal Stab Injury: A Case Report. Nepal Medical Journal. 2019; 2: 63–65.

[18] Kaliszan M. Multiple severe stab wounds to chest with cuts to the ribs. Suicide or homicide? Journal of Forensic and Legal Medicine. 2011; 18: 26–29.

[19] Scolan V, Telmon N, Blanc A, Allery JP, Charlet D, Rouge D. Homicide-Suicide by Stabbing Study over 10 Years in the Toulouse Region. American Journal of Forensic Medicine & Pathology. 2004; 25: 33–36.

[20] Nishimura T, Naito H, Nakao A, Nakayama S. Characteristics of self-inflicted injury among suicidal patients: analysis of nation-wide trauma registry. Trauma Surgery & Acute Care Open. 2021; 6: e000694.

[21] Govindaraju RC, Patil RT, Srivastava A. Successfully treated bizarre self-mutilation with disembowelment – Case report with review of literature. Journal of Forensic and Legal Medicine. 2013; 20: 588–590.

[22] Richardson AJ, Tevlin R, Larkin JO, Beddy D. Seppuku: a mod-ern approach to an ancient injury. Irish Medical Journal. 2013; 106: 211–212.

[23] Pierre JM. Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom. World Journal of Psychiatry. 2015; 5: 4–14.

[24] Kimura R, Ikeda S, Kumazaki H, Yanagida M, Matsunaga H. Comparison of the clinical features of suicide attempters by jumping from a height and those by self-stabbing in Japan. Jour-nal of Affective Disorders. 2013; 150: 695–698.

[25] Fukube S, Hayashi T, Ishida Y, Kamon H, Kawaguchi M, Kimura A, et al. Retrospective study on suicidal cases by sharp force injuries. Journal of Forensic and Legal Medicine. 2008; 15: 163–167.

[26] Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, et al. Suicidal Behavior and Alcohol Abuse. International Journal of Environmental Research and Public Health. 2010; 7: 1392–1431.

[27] Gharehdaghi J, Ghadipasha M, Hedayatshodeh M, Fallah F. Fa-tal Abdominal Stabbing: A Confusing Picture in Differentiating Homicide and Suicide. International Journal of Medical Toxi-cology and Forensic Medicine. 2019; 9: 155–158.

[28] Nishimura T, Sakata H, Yamada T, Terashima M, Shirai K, Ya-mada I, et al. Different Patterns in Abdominal Stab Wound in the Self-Inflicted and Assaulted Patients: an Observational Analy-sis of Single Center Experience. The Kobe Journal of Medical Sciences. 2017; 63: E17–E21.

[29] Costantini L, Pasquarella C, Odone A, Colucci ME, Costanza A, Serafini G, et al. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of Affective Disorders. 2021; 279: 473–483.

[30] Beck AT, Brown GK, Steer RA. Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Be-haviour Research and Therapy. 1997; 35: 1039–1046.

[31] Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. The Ameri-can Journal of Psychiatry. 2011; 168: 1266–1277.

[32] De-Giorgio F, Lodise M, Quaranta G, Spagnolo AG, d’Aloja E, Pascali VL, et al. Suicidal or homicidal sharp force injuries? a review and critical analysis of the heterogeneity in the forensic literature. Journal of Forensic Sciences. 2015; 60: S97–S107.

[33] Mazzolo GM, Desinan L. Sharp force fatalities: suicide, homi-cide or accident? a series of 21 cases. Forensic Science Interna-tional. 2005; 147: S33–S35.

[34] Banerjee A, Zhou HY, Kelly KB, Downs BD, Como JJ, Clar-idge JA. Anterior abdominal stab injury: a comparison of self-inflicted and intentional third-party stabbings. The American Journal of Surgery. 2013; 205: 274–279.

[35] Pelletti G, Visentin S, Rago C, Cecchetto G, Montisci M. Alter-ation of the Death Scene after Self-stabbing: a Case of Sharp Force Suicide Disguised by the Victim as a Homicide? Journal of Forensic Sciences. 2017; 62: 1395–1398.

[36] Abdullah F, Nuernberg A, Rabinovici R. Self-inflicted abdomi-nal stab wounds. Injury. 2003; 34: 35–39.

[37] Ohshima T, Kondo T. Eight cases of suicide by self-cutting or-stabbing: consideration from medico-legal viewpoints of dif-ferentiation between suicide and homicide. Journal of Clinical Forensic Medicine. 1997; 4: 127–132.

[38] Di Nunno N, Costantinides F, Bernasconi P, Di Nunno C. Suicide by hara-kiri: a series of four cases. The American Journal of Forensic Medicine and Pathology. 2001; 22: 68–72.

[39] Karger B, Niemeyer J, Brinkmann B. Suicides by sharp force: typical and atypical features. International Journal of Legal Medicine. 2000; 113: 259–262.

[40] Atreya A, Rijal D, Kanchan T, Shekhawat RS. Abdominal self-stabbing: a case report. The Medico-Legal Journal. 2017; 85: 97–99.

[41] Brunel C, Fermanian C, Durigon M, de la Grandmaison GL. Homicidal and suicidal sharp force fatalities: autopsy param-eters in relation to the manner of death. Forensic Science Inter-national. 2010; 198: 150–154.

[42] Simonit F, Da Broi U, Desinan L. The role of self-immolation in complex suicides: a neglected topic in current literature. Foren-sic Science International. 2020; 306: 110073.

[43] Bohnert M. Complex Suicides. In Tsokos M (ed.) Forensic Pathology Reviews (pp. 127–143). Humana Press: Totowa, NJ. 2005.

[44] Bohnert M, Pollak S. Complex suicides–a review of the litera-ture. Archiv Fur Kriminologie. 2004; 213: 138–153. (In Ger-man)

[45] Perdekamp MG, Pollak S, Thierauf A. Medicolegal evaluation of suicidal deaths exemplified by the situation in Germany. Forensic Science, Medicine, and Pathology. 2010; 6: 58–70.

[46] Austin AE, Guddat SS, Tsokos M, Gilbert JD, Byard RW. Multi-ple injuries in suicide simulating homicide: report of three cases. Journal of Forensic and Legal Medicine. 2013; 20: 601–604.

[47] De Simone S, Maglietta F, Ferrara M, Spagnolo L, Ricci P, De Carlo D, et al. Homicide or car accident: the case of the ‘guilty’ fibre. Medico-Legal Journal. 2019; 87: 77–80.

[48] Moriani S, Cecchi R, Cipolloni L. Suicide by sharp instruments: a case of harakiri. International Journal of Legal Medicine. 1996; 108: 219–220.

[49] Dawood AWA. Medicolegal aspects of 3 cases of bizarre self-mutilation. The American Journal of Forensic Medicine and Pathology. 2011; 32: 35–38.

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