Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
Forensic Sci Int. 2021 Feb;319:110662. doi: 10.1016/j.forsciint.2020.110662. Epub 2020 Dec 25.
Complex suicides are highly uncommon suicides in which multiple detrimental methods are used simultaneously or in chronological succession. We retrospectively analyzed through our database the 25512 autopsy reports registered at the Bureau of Legal Medicine of Milan in the last 27 years from 1993 until 2019, where 4498 suicides were documented. We assessed 53 cases of complex suicides and only one case of complicated suicide: for all of them we analyzed both data collected during the on-site investigation and the autopsy. In our case series, we identified a total number of 113 methods chosen and variably combined by the victims, which were classified into 17 categories. On the whole the most frequent association of suicide methods resulted in the combination of the plastic bag suffocation with inert gas inhalation (13 out of 53 complex suicides; 24.5%). We also analyzed our cases of simple suicides (1993-2019), to compare them with the complex suicides. In this study, we present a complete analysis regarding our cases of complex suicides, discussing the challenges and the interpretative issues which a forensic pathologist might deal with. A thorough on-site judicial inspection and a careful autopsy examination are crucial in such cases. Moreover, the clinical history of the victims and laboratory findings are supplemental elements to be necessarily considered to establish the actual manner of death and avoid any misinterpretations.
复杂自杀是一种非常罕见的自杀方式，其中同时或按时间顺序使用多种有害方法。我们通过数据库回顾性分析了米兰法医局在过去 27 年（1993 年至 2019 年）登记的 25512 份尸检报告，其中记录了 4498 例自杀。我们评估了 53 例复杂自杀案例，仅发现 1 例复杂自杀案例：对于所有这些案例，我们都分析了现场调查和尸检期间收集的数据。在我们的案例系列中，我们总共确定了 113 种方法，这些方法由受害者选择并以不同的方式组合，分为 17 类。总的来说，自杀方法最常见的组合是塑料袋窒息与惰性气体吸入相结合（53 例复杂自杀中有 13 例；24.5%）。我们还分析了我们在 1993 年至 2019 年期间的简单自杀案例，将它们与复杂自杀案例进行比较。在这项研究中，我们对复杂自杀案例进行了全面分析，讨论了法医病理学家可能遇到的挑战和解释问题。在这种情况下，彻底的现场司法检查和仔细的尸检检查至关重要。此外，受害者的临床病史和实验室发现是必须考虑的补充元素，以确定实际的死亡方式并避免任何误解。
