A fatal and unusual genital mutilation in an elderly man as a result of sharp force injuries and domestic dog predation

Cases of genital amputation require a careful investigation, since they may be the result of self-inflicted injuries, assaults, animal predation, or post-mortem body mutilation. In the present case, an 81-year-old man affected by liver cirrhosis and dementia and suffering from sexual disinhibition was found lying half-naked and unconscious in his courtyard; profuse bleeding in the perineal area and the absence of the external genitalia were observed. The victim was transferred to hospital and underwent surgical emergency treatment, but he died 2 days later. No sharp tools were found on the scene. Moreover, the autopsy did not reveal any defense or tentative wound on the body and no blood stains on the hands of the victim. Several linear scratches were detected close to the edges of the wound; according to the surgical report, these scratches were clean-cut in the lower part and crenated and infiltrated by blood in the cranial part. Although the medical history of the man could be consistent with self-mutilation, it was not possible to rule out the involvement of other people, including the possibility of an attempt by his relatives to cover up what may have been a self-amputation. Furthermore, the victim’s dog vomited parts of the man’s genitalia while being transported to a dog shelter. Similar cases have rarely been published in the current forensic literature

Accidental death in a jack-knife position

Postural (or "positional") asphyxia occurs due to a person being in a prolonged abnormal body position that prevents adequate breathing. Its diagnosis is based on several criteria, in particular the exclusion of involvement of other people and other causes of death. This case report is about a 73-year-old woman whose body was found in a jack-knifed position by her son. She was on the floor, wedged into the space between the legs and seat of a chair. The man attempted unsuccessfully to extricate her from that position and called for medical assistance. The rescuers took pictures of the scene before freeing the victim from the chair and providing unsuccessful resuscitation. External examination disclosed abrasions on the thighs and the back of the victim, which corresponded to parts of the chair, ecchymoses on the upper limbs (ascribed to the gripping attempts), conjunctival petechiae, facial congestion and swelling. Autopsy disclosed brain and lung congestion and edema and atherosclerotic coronary disease without acute cardiac lesions. All these considerations contributed to the cause of death being determined as being due to postural asphyxia. Keywords: Postural asphyxia, Positional asphyxia, Jack-knife position, Death scene investigatio

The 27th International Meeting on Forensic Medicine Alpe – Adria – Pannonia BOOK OF ABSTRACTS

Arrhytmogenic cardiomyopathy is a disorder characterized by fatty and fibrous replacement of the ventricular myocardium. Clinical manifestations consist of ventricular arrhythmias, syncope, progressive heart failure and occasional sudden deaths. We report the case of a 19-year old football player who collapsed immediately after beginning warming up exercise before a football training. ECG monitoring highlighted ventricular fibrillation and resuscitation attempts were unsuccessful. Past history was positive only for a hypertensive episode at age 13 and at the annual sport evaluation he was declared fit for sporting activity. Family history disclosed a myocardial infarction in a paternal uncle. Autopsy was performed according to guidelines for sudden deaths and it disclosed pulmonary oedems and congestion, a 425-gram heart weight and coronary arteries free from atherosclerotic disease. A 1 cm area of fibro-fatty subepicardial replacement was detected at the antero-lateral wall of the left ventricle and three foci of myocardial disarray surrounded by fibrosis were observed in the interventricular septum. No inflammatory infiltrate was noted and the right ventricle was unremarkable. Toxicology was negative, whereas genetic analysis was not available. The cause of the death was attributed to a fatal ventricular arrhythmia due to a left-dominant arrhythmogenic cardiomyopathy. Arrhythmogenic cardiomyopathy has been typically classified into a right ventricular (classical form) and biventricular pattern. The left-dominant phenotype represents the 5% of the overall cases and most of the literature consists of case reports. Main anatomical and clinical features of this disease are described in this communication, underlying that clinical manifestation display more often earlier than prominent morphological alterations

Disease-knowledge-related suicide by cutting subclavian catheters in a woman undergoing haemodialysis: case report and review of the literature

Patients undergoing haemodialysis have a higher incidence of depression and a higher suicidal rate than general population. In this report we present the case of a 49-year-old woman with a history of chronic renal insufficiency and subclavian catheters for haemodialysis, who was suffering from depression and alcohol abuse. She was found unconscious on her bed by her father, with profuse bleeding from the cut ends of the two catheters. After ruling out air embolism, the cause of death was ascribed to acute haemorrhage, whereas the manner of death was consistent with a suicide. This paper highlights the easier access to some peculiar suicide methods that some subjects can have due to their knowledge about their pathological conditions and/or the treatments they undergo, otherwise not available in the general population. Because of this particular feature, such self-suppressions can be termed “disease-knowledge-related” or “medical-knowledge-related” suicide

A bizarre case of fatal main renal artery partial laceration without primary kidney injury due to a single stab wound in the chest

Reno-vascular injuries are a rare type of renal injury, and their second most frequent cause is penetrating wounds. The majority of the reports and of the studies are present in the urological and radiological literature and they focus on the clinical approach to such injuries. In the case here presented, an 18-year-old male died after being stabbed in the left hemithorax. During body examination, thoracic organs were found to be unremarkable (except for a small peripheral laceration of the left lung), but the diaphragm was transfixed and the upper wall of the left main renal artery was lacerated. The adjacent renal vein, the kidney, the aorta, the vena cava and the surrounding internal structures were not damaged (except for a small laceration of the pancreatic tail). A massive haemothorax and a large retroperitoneal haematoma in the left kidney area were observed. The cause of death was attributed to haemorrhagic shock following a partial laceration of the left main renal artery due to the stab wound to the chest. No other cases of similar fatal renovascular injuries due to stab wounds have been published in the current forensic literature

ABDOMINAL SELF-STABBING AND PLASTIC BAG SUFFOCATION: A PARTICULAR CASE OF COMPLEX SUICIDE

The term “complex suicide” was used for the first time by Marcinkowski et al. in 1974 and it defines rare forms of suicide in which more than one method is used to induce death, unlikely from “simple suicides” where only one technique is involved. According to the different combinations reported in literature, complex suicides have been classified into “typical” (where two common suicide-methods are associated) and “atypical” (where more than two methods, or infrequent combinations of two suicide methods are involved). In the following case an elderly man suffering of depression was found in the shack of his house with a knife embedded in abdomen and two plastic bags fastened around his neck with a twine. Three other superficial stab wounds were clustered in the upper-left abdomen, close to the penetrating lesion. Internal examination revealed haemorrhagic infiltration at the omentum and haemoperitoneum, whereas no evident signs of asphyxia were highlighted. The cause of death was ascribed to haemorrhagic shock. Features of the crime scene and of the tools used to commit to suicide have been studied. External and internal lesions have been also examined according to the current literature. The outcome of the analysis revealed that this association of suicide methods is unusual, confirming that complex suicides represent a challenging investigation for the forensic pathologist

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 \u201ctypical\u201d (where two common suicide methods are associated) and \u201catypical\u201d (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

A burned body with a gunshot wound in the mouth and a suicide note: A complex or complicated suicide?

The body of a 53-year-old man was found in a burning car. The ignition key was in start position and the accelerator pedal was held down by his right foot. Autopsy revealed a gunshot entrance wound in the hard palate, a bullet track through the anterior cranial fossa and a projectile lodged in the left frontal lobe. The brain stem was free of lesions and any signs of secondary brain injury, such as brain oedema and intracranial haemorrhage, were not significant. Soot deposits and thermal injury to the mucosa were observed in the airways below the glottis and carboxyhaemoglobin (COHb) saturation was 40%. A single bullet case and a handgun were recovered next to the driver's seat. Fire investigators identified the motor as the beginning of the burning: therefore, the conclusion was that the car had caught fire due to overheating of the engine. Differential diagnosis between complex and complicated suicide was essential. The cause of death was identified as carbon monoxide intoxication, and the injuries to the brain were not felt to be immediately fatal. The case has been classified as a complicated suicide. There are no other published cases of a complicated suicide involving exposure to fire or the use of firearms

Submerged corpses of an elderly couple retrieved from a canal with alcohol detected in their blood: A rare case of murder-suicide by drowning?

The body of an elderly man and his disabled wife were found submerged in a canal in open country one afternoon. They had last been seen alive that morning. The man's car was parked close to the canal and the woman's wheelchair was located in a stable position a few meters from the canal bank, facing away from the water. There were abrasions and bruises on the woman's forearms and hands and lower left leg, and the man's body displayed a bruise on the left hand and an abrasion of the left thumb likely caused by a fingernail. Other observations included frothy fluid exuding from the nose and in the airways, overdistended lungs with rib impressions and clear watery fluid in the stomach of both victims. Ethanol was detected in the peripheral blood of both corpses (1.0 g/L in the woman, 0.25 g/L in the man). The man was known to be stressed and depressed: he cared for his ailing spouse, who was affected by severe cognitive impairment and he had on several occasions expressed a desire to put an end to their misery. The hypotheses of a suicide pact or a double accident were in contrast with the woman's mental state and with the position of the wheelchair, respectively. The manner of death was consistent with a spousal murder-suicide involving a double drowning. Papers reporting similar cases are infrequent in the literature

Emerging issues in the approach to submerged bodies: Water-related deaths in Friuli, northeastern Italy (1993–2020). Analysis of post-mortem reports and some unusual cases

When analysing bodies recovered from a watery environment, all manners of death, a variety of causes of death and the possibility of body disposal have to be considered. Unclear circumstances of death, unidentified victims and body decomposition may hamper a forensic investigation. The lack of specific and sensitive drowning-related autopsy findings and post-mortem blood alcohol levels (blood alcohol concentrations (BACs)) may also lead to erroneous conclusions. We reviewed the autopsy records for all bodies recovered from water in Friuli, northeastern Italy, over a 28-year period, focusing on death circumstances, autopsy findings and blood alcohol levels. Some unusual cases were examined separately. Among the 69 cases, there were 32 accidents, 13 suicides, 4 homicides, 6 natural and 14 undetermined deaths. Causes of death included 51 drownings, 6 undetermined, 5 cardiac deaths and 7 non-drownings. Six deaths in a bathtub and one diving-related death were also included. Acute alcohol intoxication was ascertained in 22 of 40 victims. Some significant limitations in the approach to water-related deaths have been highlighted: although emphysema aquosum and external foam resulted to be the most reliable indicators, a determination of drowning based exclusively on autopsy findings cannot be ascertained with certainty. Furthermore, it was found that the standard definitions of wet and dry drowning in the literature differ widely from a morphological perspective and this may lead to misleading outcomes. Post-mortem BAC changes have been critically analysed only in bodies found in cold water, and, in the absence of an alternative to blood specimens, the use of pre-set cut-off values is still necessar