Bilateral Abdominal Stab Wounds: A Forensic Diagnostic Challenge in Determining the Manner of Death – A Case Report

In general, determining the manner of death in fatal stab injuries is one of the most challenging aspects of forensic practice, particularly when the alleged history conflicts with objective forensic findings. We report a case of 47-year-old male admitted with an alleged history of self-inflicted bilateral abdominal stab injuries. Emergency exploratory laparotomy revealed perforations of the ascending and transverse colon, which were surgically repaired. During the course of treatment, the patient succumbed to septicemia secondary to perforation peritonitis five days later. Medicolegal autopsy revealed two bilateral abdominal stab wounds of similar dimensions and morphology, along with postoperative laparotomy and drain sites. The bilateral distribution of injuries, comparable wound characteristics, absence of hesitation wounds, and correlation with investigative findings were inconsistent with classical self-inflicted stab injuries and were more consistent with homicidal assault. This case highlights the indispensable role of meticulous medicolegal autopsy in determining the manner of death and emphasizes that clinical history alone should not be relied upon in differentiating suicidal from homicidal stab injuries, particularly in surgically managed cases.