Exsanguination from a puncture wound to arteriovenous fistula as the method of suicide in a chronic kidney disease patient

Abstract

In this paper we present a case of a 65-year-old man, with chronic kidney insufficiency treated with hemodialysis, found dead by his wife, lying in his bed. Based on autopsy findings, toxicological analysis, the police report and circumstances of death, it was concluded that the death was suicidal and that the cause of death was hemorrhagic shock due to fatal blood loss through a small puncture wound in an arteriovenous fistula of the left forearm, inflicted by a small Swiss Army knife. Similarly to occupation-related suicides, the victim had used his knowledge about chronic kidney disease and the relatively high pressure in an arteriovenous fistula to inform his suicidal actions, and, thus, this case might be considered a disease-knowledge-related or medical-knowledge-related suicide.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Daugirdas JT, Blake PG, Ing TS. Handbook of dialysis. 5th ed. Philadelphia: Wolters Kluwer Health; 2015.

    Google Scholar 

  2. 2.

    Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S176–247.

    Google Scholar 

  3. 3.

    Marc B, Baudry F, Zerrouki L, Ghaith A, Garnier M. Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report. Am J Forensic Med Pathol. 2000;21:270–2.

    CAS  Article  Google Scholar 

  4. 4.

    Byard RW, James RA. Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites. Forensic Sci Med Pathol. 2007;3:128–32.

    Article  Google Scholar 

  5. 5.

    Jose MD, Marshall MR, Read G, Lioufas N, Ling J, Snelling P, et al. Fatal dialysis vascular access hemorrhage. Am J Kidney Dis. 2017;70:570–5.

    Article  Google Scholar 

  6. 6.

    Gill JR, Storck K, Kelly S. Fatal exsanguination from hemodialysis vascular access sites. Forensic Sci Med Pathol. 2012;8:259–62.

    Article  Google Scholar 

  7. 7.

    Schmidt P, Padosch S, Madea B. Occupation-related suicides. In: Tsokos M, editor. Forensic pathology reviews, vol. 2. Totowa: Humana Press; 2005. p. 145–65.

    Google Scholar 

Download references

Funding

This work was supported by the Ministry of Education, Science and Technical Development of Republic of Serbia, Grant No. 45005.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Slobodan Nikolić.

Ethics declarations

Conflict of interest

The authors hereby declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Živković, V., Cvetković, D. & Nikolić, S. Exsanguination from a puncture wound to arteriovenous fistula as the method of suicide in a chronic kidney disease patient. Forensic Sci Med Pathol 16, 352–354 (2020). https://doi.org/10.1007/s12024-019-00151-0

Download citation

Keywords

  • Suicide
  • Exsanguination
  • Arteriovenous fistula
  • Chronic kidney insufficiency
  • Occupation-related suicide