Suicide by abdominal wounds suggesting seppuku: Case reports from Romania and an international literature review

Suicide by abdominal wounds suggesting seppuku: Case reports from Romania and an international literature review. Claudia Judea-Pusta, Alexandru Rusu, Andreea Camarasan. Aggression and Violent Behavior, Volume 47, July–August 2019, Pages 68-73. https://doi.org/10.1016/j.avb.2019.03.006

Highlights
•    In Romania this type of suicide is rarely practiced, commonly seen in older males.
•    Frequently the victims suffer from a mental illness, or are alcohol users.
•    The tool used is the knife; the lesions are located in the middle abdominal axis.
•    The mortality rate is higher in cases of abdominal wounds suggesting seppuku.
•    It is important to establish a differential diagnosis between suicide and homicide.

Abstract: Seppuku is a traditional suicide method practiced by honorable Japanese samurai. Today this method of suicide is rarely used in Japan or worldwide and may be exceptionally encountered in patients suffering from psychiatric disorders, the majority of them being older men. It is well known that clinical and cultural factors also play a role in practicing this method of suicide. The mortality rate is significantly higher in cases of abdominal wounds suggesting seppuku, compared to the mortality rate caused by simple stab wounds. Death can occur immediately through massive external or/and internal hemorrhage as well as later on through complications, often septic. In the Romanian forensic literature files, suicide by abdominal stabbing suggesting seppuku is rarely encountered and documented. When investigating violent deaths owing to sharp force, the role of the forensic pathologist is not only to establish the cause of death and the mechanism used for creating the lesions, but also to identify the object used for inflicting the injuries, the type of the injuries, allowing thus to formulate a conclusion from legal perspective upon the act itself: suicide or homicide? The present paper reviews the international literature and presents three cases of suicide by self- inflected abdominal stab wounds suggesting seppuku, autopsied at the Bihor County Forensic Service, Romania, during 2013–2017.