Egyptian Journal of Forensic Sciences (2016) 6, 492–495

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Egyptian Journal of Forensic Sciences

journal homepage: http://www.journals.elsevier.com/egyptian-journal-of-forensic-sciences

CASE REPORT

An atypical case of suicidal cut throat injury

Sachin Sudarshan Patil *, Ravindra Baliram Deokar, Sunil Gorakh Vidhate,
Shashank Tyagi

Dept. of Forensic Medicine, Seth GSMC and KEM Hospital, Mumbai, State – Maharashtra 400 012, India

Received 7 July 2015; revised 28 February 2016; accepted 18 April 2016

Available online 6 May 2016

KEYWORDS Abstract The most commonly used methods for committing suicide in India are hanging, poison-
Suicide; ing, burns, jumping from height, drowning, firearm injuries, stab injuries etc. Cut throat injuries
Cut throat injury; using a sharp weapon is the least frequent suicidal method. Tentative cut marks are common in sui-
Tentative cuts cidal deaths. Committing suicide by cutting their throat without hesitation marks is a very rare
occurrence. We present a case of 32 year old male, suffering from psychiatric illness brought dead
to tertiary care hospital with suicidal cut throat injury and not associated with tentative cuts and
tailing of wound.
Ó 2016 The International Association of Law and Forensic Sciences (IALFS). Production and hosting by
Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

1. Introduction by religious, cultural, and social values in its occurrence.4 The

Suicide is one of the three leading causes of death among the
persons of age between 15 and 34 years throughout the world.1
According to the WHO, almost one million people commit
suicide and 20 times more people attempt suicide every year.
A global mortality rate is 16 per 100, 000.2
An Indian study showed that the highest suicide rate was in
the 15–29 years age group (38 per 100,000 population) fol-
lowed by the 30–44 years group (34 per 100,000 population).
In those persons aged 45–59 years, the rates of suicide was
18 per 100,000 and 7 per 100,000 in those aged >60 years.3
The incidence and pattern of suicide differs from one geo-
graphic region to another because of the important role played
most commonly used methods for committing suicide in India
are hanging, poisoning, burns, jumping from height, drown-
ing, firearm injuries, stab injuries etc.5 Cut throat injuries using
a sharp weapon is the least frequent suicidal method.6,7 Tenta-
tive cut marks are common in suicidal deaths.8,9 Committing
suicide by cutting their throat without hesitation marks is a
very rare occurrence.10–16 From this case, we highlight that
the possibility of self inflicted cut throat injury should be ruled
out in initially suspected homicidal cut throat injury cases
without relying totally on the characteristic autopsy features
for correctly establishing the manner of death.
2. Case report

* Corresponding author at: Dept. of Forensic Medicine, 2nd floor, 2.1. History
Library Building, Seth GSMC and KEM Hospital, Mumbai, State –
Maharashtra 400 012, India. Tel.: +91 9757179483, +91 8108609282. A 32 year old male arrived at a coconut shop in a public place
E-mail addresses: drsach_patil7@redifmail.com (S.S. Patil),
in the afternoon. Coconut vendor being busy with other cus-
ravideo80@gmail.com (R.B. Deokar).
tomers, taking advantage of the situation the deceased grasped
Peer review under responsibility of The International Association of
Law and Forensic Sciences (IALFS). the knife, routinely used for cutting coconuts and cut his

http://dx.doi.org/10.1016/j.ejfs.2016.04.003
2090-536X Ó 2016 The International Association of Law and Forensic Sciences (IALFS). Production and hosting by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
An Atypical Case of Suicidal Cut Throat Injury
throat with that knife in the presence of many people at the
venue. He immediately fainted down in the pool of blood
and was brought to King Edward Memorial hospital, Mumbai
in an injured condition where he was declared as brought dead.
The body of the deceased was sent to mortuary for post-
mortem examination at our post-mortem centre.
The identity of the deceased was revealed on the same day.
On detailed investigations by police and information from rel-
atives, it was revealed that the deceased was right handed and
was suffering from depression since 01 year. He was taking
antidepressant medications for the same in the outpatient
department. Also there was history of previous suicidal
attempts in the form of multiple incisions over front of left
forearm few months back. He was a trained worker in a
slaughter house, where he used to regularly cut throats of
many animals as a part of his job.
2.2. Autopsy findings
2.2.1. External examination
Body of the deceased was averagely built and averagely nour-
ished. Rigor mortis was well marked all over the body. Post
mortem lividity was ill-appreciated and present over back of
trunk except over pressure areas and was fixed. Multiple old
healed linear scars were present over anterior aspect, middle
1/3rd of left forearm, horizontally placed and of length varying
from 6 cm to 3 cm (Fig. 1).
2.2.2. Local examination
Cut throat injury was present over anterior aspect of neck,
slightly obliquely placed at the level of laryngeal prominence
in midline, 7 cm below the chin and 7 cm above the supra-
sternal notch. It was situated 05 cm below the tip of the right
mastoid and 4.5 cm below the tip of the left mastoid measuring
20 cm  06 cm  bone deep. Margins were clean cut showing
irregular skin tags in between at places. Both angles of injury
were cleanly cut and acute. Underlying thyroid cartilage,
Figure 1 Multiple old healed linear scar marks over anterior
aspect of left forearm; it indicates tendency of self-mutilation.
493
supraglottic part of larynx, laryngo-pharynx, soft tissue, blood
vessels and musculature were cleanly cut corresponding to sur-
face injury along with cut fracture of body of fifth cervical ver-
tebra measuring 04 cm in length and maximum depth of 3 mm
(Fig. 2a and b). Internal jugular vein and external carotid
artery on the left side were incised at the level 1 cm above
the origin of external carotid artery (Fig. 3a). The right sided
carotid artery and its main branches were spared. No tentative
incisions and tailing of wound were present over the neck
(Fig. 3b).
2.2.3. Internal examination
Brain was pale and oedematous. Heart shows no morpholog-
ical abnormality or injury and was pale. Rest of all the organs
were pale.
2.2.4. Viscera preservation
Routine viscera and blood preserved, packed, labelled and
sealed during autopsy. It was further sent for chemical analysis
with maintenance of proper chain of custody.
2.3. Toxicological analysis reports from chemical analysers
Toxicological analysis did not reveal the presence of any poi-
son or alcohol.
2.4. Final cause of death
Opinion as to the cause of death was haemorrhagic shock due
to cut throat injury caused by sharp edged weapon.
3. Discussion
In homicidal attacks, cut-throat injuries and stab wounds to
the neck induced by sharp weapons are often life endanger-
ing.17–19 The proper evaluation of neck injuries case by case
will help in differentiation between homicidal, suicidal and
accidental injuries by the Forensic experts.20,21
A typical suicidal cut throat incision is oblique, starting on
the upper part of the left side of neck, below the angle of jaw
and terminating on the right side in the right handed person.
Depth of the incision is more at the commencement while it
becomes shallower as it crosses the throat, giving an indication
regarding the direction of the slit and the handedness of the vic-
tim.10 Agnihotri22 stated that usually suicidal wounds are incised
while homicidal wounds are usually chopped and stab wounds.
Cut throat extending up to the vertebrae is suggestive of homici-
dal injury while its absence is indicative of suicidal injury.9,12
Suicidal incised neck wounds are classically numerous,
being characterised by a number of cuts at the superior end
of the wound known as tentative cuts/hesitation marks. Their
presence suggests self-infliction, indicating repeated attempted
cuts being stopped because of pain or hesitancy before finally
cutting through the skin.11,23–25 In these victims, hesitant
superficial and parallel marks are commonly present on other
accessible parts of the body – sometimes it is possible to
observe scarring of the wrists from previous suicide attempts.
An additional aspect of self-inflicted injury is that cut or stab
wounds are usually found on sites that are easily reachable,
not covered by clothing or on sites uncovered after the clothing
494 S.S. Patil et al.

Figure 2 (a) Note the clean cut thyroid cartilage and underlying structures. (b) Cut fracture of body of fifth cervical vertebra.

Figure 3 (a) Cut injury to left external carotid artery. (b) Cut throat injury with no tentative cuts.

are pulled out. The absence of defensive wounds is also an

important feature in sustaining the suicide hypothesis. Tailing
of wound can be found in suicidal cut throat injuries. Suicidal
note can be found at the scene of crime. The clothing did not
show any kind of damage which is commonly observed in
homicidal fatalities.26
In the present case, autopsy findings show the presence of
single cut throat injury over anterior aspect of neck, slightly
obliquely placed at the level of laryngeal prominence in mid-
line, extending deep up to the vertebrae. It was not associated
with tentative cuts or tailing of wound which is suggestive of
non suicidal cut throat injury over the neck. Crime scene inves-
tigation reveals knife was found by the side of dead body in the
pool of blood (Fig. 4). Very deep cut throat injury caused by
knife extending up to cervical vertebrae and not associated
with tentative cuts or tailing of wound has not been reported
in the literature as per the best of our knowledge while suicidal
cut throat injury extending up to cervical vertebrae using elec-
tric circular saw is reported.27 In context with this case, suici-
dal cut throat injury extending to cervical vertebrae can be
attributed to the psychiatric disorder and occupation of the
deceased in a slaughter house.
Figure 4 Crime scene showing pool of blood and sharp knife.
An Atypical Case of Suicidal Cut Throat Injury
Circumstantial evidence, the absence of any defence wounds
on the body, the presence of psychiatric illness and previous sui-
cidal attempt confirmed by the presence of linear scars over
anterior aspect of left forearm, were suggestive of the fact that
cut throat injury is suicidal in nature which was confirmed by
the statements given by the eye-witnesses at the crime scene.
4. Conclusion
Cut throat is not the commonly preferred method for commit-
ting suicide. Homicidal cut throat injuries are more commonly
found in others studies. The most important task for forensic
expert is to distinguish between suicidal and homicidal cut
throat injuries. Therefore in crime scene investigation, the
deceased’s medical history as well as all autopsy and toxicolog-
ical findings must be considered with a sceptical approach
before being able to establish the manner of death.
Medical help should be provided once the person shows any
symptoms and signs of suicidal tendency. Attempts should be
made to reach out to these individuals and proper counselling
should be done so as to enable them to cope with the situation.
From this case, we highlight that the possibility of self
inflicted cut throat injury should be ruled out in initially sus-
pected homicidal cut throat injuries cases without relying
totally on the characteristic autopsy features for correctly
establishing the manner of death.
Funding
None.
Conflict of interest
None declared.
Ethical approval
Not applicable.
Contribution
All the authors contributed equally in conception, analysis and
interpretation of case as well drafting, revising the manuscript
and approval of final version.
Acknowledgements
I would like to thank Dr H.M. Pathak, Professor and Head,
Forensic Medicine, Seth GSMC & KEMH, Mumbai & Dr
RB Sukhadeve, Professor, Forensic Medicine, Seth GSMC &
KEMH, Mumbai for their valuable guidance. I am also thank-
ful to my wife Kavita, my parents and my brother for their
constant support and encouragement.
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