Self-inflicted Thoraco-abdominal stabbing followed by bathtub drowning: Reconstruction of the terminal mechanism in a complex suicide.

Complex suicide involving sharp-force injury and drowning may closely mimic homicide and requires careful reconstruction of the terminal mechanism. We report an anonymized case of a 27-year-old man found prone in a bathtub containing water mixed with blood after emergency entry into his apartment. Blood traces were documented in several rooms. Autopsy identified 18 stab-incised wounds of the precordial and epigastric regions, hesitation-type superficial injuries, old linear forearm scars, and no defensive injuries. Seven wounds penetrated the thoracic cavity; however, the limited right ventricular injury and approximately 100 mL of hemopericardium did not support rapidly fatal cardiac tamponade or immediate exsanguination. Persistent fine froth, overdistended waterlogged lungs, gastric liquid content, liquid blood, and visceral congestion supported drowning only when interpreted in the overall investigative context. Hand maceration was considered an immersion-related change, not evidence of vital drowning by itself. Scene blood distribution indicated preserved mobility after stabbing. Integration of wound accessibility, injury severity, post-injury mobility, drowning-supportive findings, toxicology, histology, and circumstantial information supported a suicidal manner of death, with drowning as the terminal mechanism. This case illustrates the forensic value of structured scene-autopsy reconstruction when multiple potentially fatal findings coexist.