A FATAL WRIST INCISED WOUND: A CASE OF HOMICIDE

MIMICKING SUICIDE
Umanah I. N, 1 Akhiwu W, 2 Ochang A, 3 Tanimowo M. 1 Department of Pathology, University of Uyo Teaching Hospital
1 2
(UUTH), Uyo Police medicals, Force Headquarters, Abuja and Department of Medical Microbiology & Parasitology, UUTH,
3
Uyo, NIGERIA

Abstract Eye witness accounts state that he was chased by some

people during which he had to scale a wall. Although the
Crime scene staging is uncommon in Africa. A 26 year sound of a gunshot was heard during this period, nobody
old male was found dead on the outskirts of a market could ascertain where it came from, even though policemen
with cuts on both hands. There were no other sharp force had been invited to forestall breakdown of law and order.
injuries or features of blunt trauma. The autopsy Autopsy histologic examination findings showed acute
revealed acute tubular necrosis of the kidneys indicative tubular necrosis of the kidney and microvesicular steatosis
of ante mortem hemorrhage and prolonged survival of of the liver. Toxicology could not be done due to the lack of
the victim. We report a case of homicide by wrist incision available facilities in our environment. We concluded that
simulating suicide. the cause of death was exsanguination and that there was
Distinction between murder and suicide may be prolonged survival after the injury.
impossible by an examination of the body alone. The
purpose of this paper is to emphasize that in every case
with fatal sharp weapon injuries, differentiation
between suicide and homicide is always required.
Keywords: fatal injury, wrist incision, suicide, homicide
Fig. 1: Fatal left wrist injury. Other superficial cuts
(Upper arrows) including parallel cuts adjacent to
Introduction fatal wound which appeared to be hesitation marks
Death by wrist cutting is usually suicidal 1,2 . Homicidal (lower arrow).
cutting of the wrist with the intent of simulating suicide is
rare and can present diagnostic difficulties. This was a
novel case of wrist cutting by a suspected mob, in which
the autopsy findings and forensic evidence were crucial in
differentiating between suicide and homicide. To the best
of our knowledge, there are no other reported cases of
homicide by isolated incised wrist wound in literature.

Case report
A 26 yr old young man was found dead on the outskirts
of a town market at 22.10 hours. There was a deep cut on
the left wrist, and superficial lacerations on the right palm,
otherwise there were no other external injuries on other
parts of the body. The body was deposited in the mortuary
and a formal report made to the police who immediately
requested an autopsy. The time of death was estimated to
be between 15.00h and 21.00h the same day based on the
specific death signs and the body temperature.
The ensuing autopsy showed a clean, deep incised wound
measuring 60mm across the left wrist and completely
severing the ulnar artery (Fig. 1, Fig.2a) In addition,
several smaller, superficial incised wounds (simulating
hesitation or tentative marks) that ran parallel to the
incised wound on the left wrist were seen. The right palm
had a superficial incised wound measuring 30mm as well
(Fig. 2b). There were no other external or internal features
of trauma. At this point, it looked like suicide.
Investigation of the scene of crime had yielded no cutting
implements. The deceased was a right handed university
undergraduate who also engaged himself in the daily
collection of illegal toll fees, a token amount imposed
by influential local authorities, from market women.
Earlier the same day, he was seen pursued by a crowd of
commercial motor cyclists popularly known as 'Alalok.

Correspondence:Dr Ivy N. Umanah MBBS,FMCPath Department of Pathology,

University of Uyo Teaching Hospital (UUTH), Uyo, P.M.B. 1136, 23 Ibom Medical Journal Vol.4 No.1 June,2011
AKS, NIGERIA. West Africa Email: innumah@gmail.com
Tel: +234-8052705131
 A Fatal Wrist Incised Wound...
Fig. 2 : Left (a) and right (b) hands showing incised wounds. Compare fatal wound (thick arrow; left) with superficial
laceration on right palm.
a b
Discussion
Distinction between homicide and suicide is a major issue
in forensic pathology. In their paper on suicide, Oshima
and Kondo stated that in every case with fatal sharp wound
injuries differentiation between homicide and suicide is
always required. 1 In this case, the pattern of injuries we
found at autopsy, especially the deep cut on his left wrist
initially suggested suicide. For a victim who was allegedly
under mob aggression and was possibly lynched, it was
intriguing that there were no other sharp force injuries or
features of blunt trauma. Deaths from isolated incised
wounds of the arm and/or hand are uncommon and usually
suicidal. 1,2 In cases of homicides, such hand lesions are
often defense wounds which commonly involve both sides
and are more widely distributed.1-4 Homicidal death from
isolated wrist incision is extremely rare and this appears to
be the first reported case in literature. We noted the location
of the injury on the left hand and the deceased's right
handedness since the relationship between the injury
localization and the victims' handedness is important. Fatal
incision wounds on the arm and/or hand of most suicide
victims are most commonly found on the left, when the
victim is right handed. 1 Other clues such as the superficial,
parallel cuts near the fatal incised wound simulating
hesitation or tentative marks, and the absence of blunt
trauma indicative of beating, were initially indicative of
suicide in this case. Hesitation marks are often found in
most cases (>70 %) of suicides from sharp weapon injury 1,5
Although the victim's external injuries appeared to be
self-inflicted, circumstantial evidence indicated homicide.
24
Crime scene investigation is crucial in distinction between
homicides and suicides and in this case there were several
eye witness accounts of mob aggression directed at the
deceased in the same market his body was later found. The
absence of any cutting implement or weapon at the scene
suggests a criminal act. 2 Another major factor in favor of a
homicide in this case was the absence of a prior psychiatric
history in this victim. Specific enquiries from family did
not yield any information suggestive of a prior intent to
commit suicide.
On further consideration, the pattern of the victim's
incised wound to the right palm was inconsistent with
suicide. It is generally considered that a wound is unlikely
to be present on the right hand/arm of the victim if he is
right handed although an unusual case was reported by
Fukomoto in Japan 6. Although the victim had smaller,
contiguous cuts resembling hesitation marks near the
victim's fatal wound, hesitation or tentative marks have
been reported in cases of homicides, sometimes inflicted
during attempts made by the victim to pull away 3,7. On the
upper limbs, hesitations marks were more often observed
on the anterior aspect of the limb, while defense wounds
were equally distributed on the anterior and posterior
aspect in a recent study.4
In critical cardiovascular trauma, collapse and death are
fairly rapid, usually within minutes.
8
In this report, the
deceased's left ulnar artery was completely severed.
Although this portends rapid collapse and death, the
autopsy findings of acute tubular necrosis in the kidneys
indicate prolonged survival of the deceased after the cut.
Ibom Medical Journal Vol.4 No.1 June,2011
 Umanah I. N et al
His activities in the period before death, like the murder
weapon, remain a mystery also indicative of crime. Karger
et al reported the unusual case of a 48 year old woman who
survived for six hours after fatal right ulnar trauma and in
the intervening period, dressed her wound and walked. 9
The sophistication exhibited in the planning and
execution of this homicide is unprecedented in a Nigerian
setting such as ours. However the likely involvement of
the deceased with questionable groups in the course of his
'toll' collecting activities in the market may be attributed to
this manner of death. These groups, known to operate in a
typical gang-like fashion, use force or threat of violence to
ensure clients' compliance. 10,11
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Conclusion
Circumstantial evidence, crime scene investigation,
statements by relatives and neighbors, the absence of blunt
trauma injuries and autopsy findings of prolonged survival,
indicated that the deceased had been a victim of homicide
rather than suicide. In every case with fatal sharp weapon
injuries, differentiation between suicide and homicide is
always required.
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25 Ibom Medical Journal Vol.4 No.1 June,2011