Self-inflicted abdominal stab wounds
Introduction
Suicide is the ninth leading cause of death in the US with more than 30,000 annual fatalities [1]. Self-inflicted abdominal stab wounds (ASWs) account for a very small fraction of these victims. Furthermore, the few reported series of suicide by self-stabbing which are all derived from forensic and psychiatric literature provide only limited trauma-related clinical information [2], [3], [4], [5], [6], [7]. The present retrospective review of 23 cases of self-inflicted ASWs from two level I trauma centres aimed to comprehensively characterize the clinical profile of this uncommon group of patients.
Section snippets
Methods
This retrospective study includes cases admitted during a 10-year period to two urban level I trauma centres (Thomas Jefferson University Hospital in Philadelphia, PA and Yale-New Haven Hospital (YNHH) in New Haven, CT). These institutions provide care to both inner city and suburban populations. The Jefferson trauma service is one of five level I trauma centres that serve the greater Philadelphia area (∼5,000,000 residents). YNHH serves the New Haven area and the eastern part of southern
Results
The present study reviewed 23 cases of self-inflicted abdominal injuries in 22 patients (Table 1). One patient accounted for two cases, which occurred 6 months apart.
Sixteen of the patients were males. Age distribution was bimodal with peaks before 50 and after 65 years. The mean age of male, female and all patients was 41, 39 and 40 years, respectively.
Most patients had an established psychiatric history (17/23) which included affective disorders (10/23), psychotic disorders (2/23), and
Discussion
The main finding of the present study is that abdominal and retroperitoneal injuries from self-inflicted ASWs in patients who present alive to the Emergency Department can be significant but most likely non-lethal. This is evidenced by the ISS, RTS and GCS of the patients as well as by their haemodynamic stability and the lack of injury-related mortality. In agreement with this observation, a recent study of 10 psychiatric patients with self-stabbing of which 9 were located in the abdomen, also
References (14)
- et al.
Suicide by self-stabbing
Forensic Sci. Int.
(1992) - et al.
Harakiri and suicide by sharp instruments in Japan
Forensic Sci.
(1973) Homicidal and suicidal sharp force fatalities in Stockholm, Sweden
Forensic Sci. Int.
(1998)- Peters KS, Murphy SL. Deaths: final data for 1996. National Vital Statistics Report 47(9), DHHS Publications no. (PHS)...
- et al.
Harakiri: a clinical study of deliberate self-stabbing
J. Clin. Psychiatry
(1994) - et al.
Patterns in sharp force fatalities—a comprehensive forensic medical study. Part 2. Suicidal sharp force injury in the Stockholm area, 1972–1984
J. Forensic Sci.
(1988) - et al.
Suicide by self-stabbing in the city of Tokyo—a review of accumulated data from 1976 to 1995
Jpn. J. Legal Med.
(1997)
Cited by (43)
Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent
2021, Journal of Surgical ResearchComplex suicides: A review of the literature with considerations on a single case of abdominal self stabbing and plastic bag suffocation
2018, Forensic Science InternationalCitation Excerpt :The most involved organs were liver and omentum (11/75), followed by small bowel (8/75), stomach and mesentery (both 6/75). Venara et al. [35] observed internal lesions in 4/9 cases (44%), specifically liver (2/9) and colon and epigastric pedicle (1/9), Abdullah et al. [36] in 14/23 cases of abdominal self-inflicted wounds: in this latter study the most common injured organs were stomach, duodenum, small bowel, colon, inferior vena cava and psoas muscle, the mesentery was damaged only in 3/23 cases. Unless the bag is still present, in cases of plastic bag suffocation autopsy can present great difficulty: generally, pathological features are entirely non-specific and the evaluation of the scene is essential [55].