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Suicidal explosions that lack a terrorist background are only rarely encountered in the field of forensic pathology. The investigation of explosion-related fatalities can be a substantial challenge in medicolegal casework. Determining whether the manner of death is suicide, homicide, or accident in such cases can present an especially difficult task to the forensic pathologist. This study considers the pathologic features of suicidal deaths caused by explosives without a terrorist background. The modus operandi of the decedents reflected familiarity and proficiency, or at least a degree of specialized knowledge, with the construction and use of explosive devices. All explosions were set off in confined spaces. The injury patterns consisted of a combination of primary blast injuries (e.g. decapitation, traumatic amputation of limbs, gross lacerations of the body surface, blast injuries of gas-containing and hollow organs), secondary blast injuries (e.g. splinter-induced penetrating trauma), tertiary blast injuries (e.g. abrasions and contusions), and burn injuries (mostly of the flash type). The previously described symmetric distribution pattern of injuries in suicidal explosions was apparent only to a certain degree in the present series. Our observation of superficially sharp-edged wound margins with bridging in the depths of the lesion in blast-induced lacerations of the skin should deserve further attention in forthcoming cases of explosion-related fatalities because this finding is a diagnostic possibility that may support the theory of an explosion-related fatality under special circumstances, e.g. when the body has been dumped away from the place of death. Because a terrorist attack may be initially suspected in each case of suicide involving explosives, the importance of a joint inquiry based on expertise from police investigators, bomb experts, and forensic pathologists is evident.

A 46-year-old woman who had had a long-term schizoid psychosis collapsed on the street. Upon admission to the hospital, she was determined to have an acute abdomen. The chest radiograph showed metallic foreign bodies in both main bronchi; foreign bodies in the stomach were not observed clinically. The woman died from repeated cardiac arrest shortly after hospital admission. At the autopsy a screw and a nail were found in both main bronchi. The abdominal cavity contained 2 L of greenish purulent fluid and a massive fibrinoid peritonitis was observed. Two perforations of the stomach, each 1 cm in diameter, were detected. The stomach was completely filled with a mass of metallic foreign bodies, greenish fluid, and a bezoar of a total weight of 1,400 g; 422 distinguishable and mostly metallic foreign bodies were counted. Death was attributed to cardiac arrest in delayed shock after massive purulent peritonitis caused by two gastric perforations combined with obstruction of the airways by aspirated foreign bodies. Cases of massive swallowing of foreign bodies are mainly restricted to mentally handicapped persons, especially schizophrenics, whereas acute impaction of the larynx by large food particles occurs nearly exclusively in heavily intoxicated adults.

We report two cases of suicide by multiple gunshots to the head. The first victim (of two shots) fired the first shot, which was observed, into his mouth, leading to damage to the left optic nerve and frontal lobe. The man still was able to drive his car home, where he shot himself in his right temple. He died 2 days later. The second victim (of three shots) was a 58-year-old man who was found dead on his bed. Reconstruction of the case disclosed that the first shot had passed through his tongue and slightly damaged the second cervical vertebral body. He then shot himself in his right temple, leading to damage of the temporal lobe. Finally, he shot himself in his left temple, resulting in destruction of the pons. In the first case, an amateurishly modified 8-mm blank revolver firing 6.35-mm- (.25)-caliber ammunition was used; in the second case, a rifle firing 5.6-mm (.22)-caliber ammunition with a reduced charge was used. In both cases, low-energy transfer to brain tissue by the initial bullets was due to low bullet energy or due to the bullets' missing the brain or vital centers.