A body with multiple stab wounds can raise suspicions of homicide; however, these suspicions can be dispelled by a thorough analysis of the scene investigations and forensic examination results (Brunel et al., 2010; Burke et al., 2018).
A single-stab wound was identified in 29% of the sharp-force suicidal fatalities (Brunel et al., 2010). In addition, single-stab homicidal injuries were detected in 78.8% of the sharp force fatalities (Burke et al., 2018). Furthermore, multiple stab injuries and complex suicides could be detectable in suicidal deaths. Indeed, medicolegal differentiation between suicide and homicide is required in these cases (Kaliszan et al., 2010; Hösükler et al., 2022; Zengın Eroglu et al., 2017; Kranioti et al., 2017).
The planned complex suicides were commonly inflicted using two methods and mainly involved male victims in their resident area (Kaliszan et al., 2010; Hösükler et al., 2022; Zengın Eroglu et al., 2017; Kranioti et al., 2017). As an example of a complex suicide involving two knife-related stabs, the proximity of the two knives in the present case suggests that the victim inflicted injuries sequentially with the two sharp objects. He attempted suicide by stabbing himself in the abdomen and heart. In complex suicides, less lethal methods are typically employed prior to more fatal ones (Zengın Eroglu et al., 2017).
Homicidal sharp object wounds were mainly identified in the front of the neck, chest, and abdomen (Issa et al., 2016), whereas suicidal ones primarily targeted the wrist, neck, pericardium at the intercostal and subcostal spaces, and epigastrium (Kaliszan et al., 2010; Hösükler et al., 2022; Patil et al., 2016). This finding is consistent with our case in which the lethal stab wound was discovered in the left subcostal region.
Using two opposed knives in suicidal stabbing could result in wounds with the same trajectory alongside different orientations as the victim’s position was not changed. However, homicidal stabbing wounds had different trajectories depending on the body’s position during the fighting and escaping (Kaliszan et al., 2010; Patil et al., 2016; Phoenix & Indiana, 2017).
As in most suicides, the victim unbuttoned his shirt and lifted his T-shirt to explore the stabbing area (Issa et al., 2016; Burke et al., 2018; Kranioti et al., 2017; Phoenix & Indiana, 2017). However, the tentative wounds were not identified.
Tentative wounds are superficial sharp object wounds confined to the skin layers. They are useful predictive signs of suicides, as their presence with the absence of defensive wounds and the cloth tears can differentiate suicide from homicide (Rockett et al., 2018; Kranioti et al., 2017). As tentative wounds could be observed in homicidal deaths (Kaliszan et al., 2010; Brunel et al., 2010; Phoenix & Indiana, 2017) but not in suicidal deaths, we could not distinguish suicide from homicide based solely on their presence (Patil et al., 2016).
The presence of suicidal letters and the absence of fight signs are related to the suicide phenomenon. According to the Interpersonal Theory of Suicide, Fernández-Cabana et al. (2015) stated that suicidal factors could be identified from suicidal notes, and both interpersonal risk factors, including the feeling of being a burden and lack of belonging to a group, were the most commonly detected factors (Fernández-Cabana et al., 2015).
In the present case, the distribution of the blood, the position of the body, and the proximity of the two knives assumed that the victim inflicted injuries himself using the found sharp objects. The sequence of wound infliction could be as follows: first, the victim inflicted the abdominal wound; nonetheless, the abdominal wall thickness and the penetration angle led to the non-fatal injury of the peritoneum without obvious bleeding (Phoenix & Indiana, 2017). Because of failing of this attempt, the victim inflicted a lethal cardiac wound with another weapon. The conversion from lesser to greater fatal techniques is typically seen in complex suicide cases (Hösükler et al., 2022; Parroni et al., 2002; Zengın Eroglu et al., 2017).
Two knife-related stabs in one suicidal case have been infrequently described in literature, but feeling of guilt and inability to adapt to challenging situations can increase self-directed aggression (Kaliszan et al., 2010).