CASE REPORT

Suicide Decapitation by a Detonating Cord

A Case Report
Maliha Khara, MD* and Jayantha C. Herath, MD, FRCPC†

the body is presented for death investigation in isolation from

Abstract: In the field of forensic pathology, suicides consist of a consid-
erable portion of the workload. Among the many methods used to commit
suicide, using a detonation cord explosive is quite unique. We report the
case of a man who committed suicide by detonation cord resulting in de-
capitation. This case report highlights the fact that the injury patterns ob-
Downloaded from http://journals.lww.com/amjforensicmedicine by BhDMf5ePHKbH4TTImqenVCbF2BRbWAbd74eqLDNb4OFIKZKjCUU6tGsREA31HP6IZB+Ao9oqk3Q= on 07/30/2019
the scene information or explosive device. In addition to a detailed
postmortem examination, ancillary testing with imaging can prove
useful in documentation of subtle, nonmacroscopic findings. These
can include musculoskeletal injuries such as vertebral fractures,

served in explosion-related deaths can be highly variable and that in cases
with isolated injuries postmortem imaging and histology are an important ad-
junct to the standard death investigation. The ultimate goal of explosion-related
investigations should be geared toward a well-documented and complete post-
mortem examination with the appropriate use of ancillary studies that provide
a clear interpretation of the mechanism, cause, and manner of death.
Key Words: blast, decapitation, postmortem radiology, suicide
(Am J Forensic Med Pathol 2019;40: 140–143)
L iterature is filled with studies based on war/terror-related
bombings. These studies have established that the type and se-
verity of explosion-related injury are highly variable and depen-
dent on type, size, and placement of explosive as well as the
environment (open air or closed space) and distance from the ex-
plosive.1 Suicides using explosives are relatively rare; however,
incidence rates as high as 41% have been reported in some coun-
tries.2 It is important to note that majority of explosive-related
suicides are centered around damage to the head and trunk with
different patterns of blast injury.3 The damage can be caused by
direct effects of the explosive, or it can be classifiable as primary,
secondary, tertiary, and quaternary injuries. Primary blast inju-
ries are described as direct effects of the pressure wave on body.
These injuries are seen in gas-filled organs such as lungs, gastro-
intestinal tract, and middle ear and usually present as hemorrhage
and perforation of these organs. Secondary blast injuries are caused
by effects of projectiles striking the body such as shrapnel embed-
ded within the explosive, and these can be difficult to assess if the
body is macerated. Tertiary injuries are a result of body being
thrown away from the blast site as a result of the blast pressure
wave. Last but not the least, quaternary blast injuries are described
as injuries that occur because of other environmental changes that
happen as a result of the blast such as building collapse, fire, or
smoke-related injury.4
Contrary to common belief, the damage from self-inflicted
explosives does not necessarily have to be diffuse. This can pose
a potential problem to the examining forensic pathologist when
Manuscript received September 7, 2018; accepted September 27, 2018.
From the *Department of Pathology and Molecular Medicine, Queen's University
and Kingston General Hospital, Kingston; and †Ontario Forensic Pathology
Service, University of Toronto, Toronto, Ontario, Canada.
The authors report no conflict of interest.
Reprints: Maliha Khara, MD, Department of Pathology and Molecular
Medicine, Queen's University and Kingston General Hospital, 76 Stuart St,
Douglas 2 Resident's Room 8-223, Kingston Ontario, Canada K7L 2V7.
E-mail: Maliha.khara@queensu.ca.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0195-7910/19/4002–0140
DOI: 10.1097/PAF.0000000000000446
facial and nasal skeletal injuries, upper airway injuries, air emboli,
and contusion injury to the brain without any overlying trauma.
Postmortem imaging can also serve as a tool to identify personal
effects, locate embedded foreign material that can pose a safety
risk to personnel, reveal medical devices that may help with body
identification, and allow for autopsy planning.5 Histological sampling
of the primary blast injuries can provide valuable information about
the microscopic properties of the explosive and chemical effects
on the tissue site. A comparative microscopic analysis of embed-
ded foreign bodies and the explosive used can be used to identify
whether it was the same explosive or not.
CASE
The torso of a 64-year-old man was found by the police un-
der a large tree with the head a few feet from the body. According
to information provided by the coroner and police, the decedent
had sent a text providing his location and instructions after his
death, a few hours prior to his death. The decedent also had work-
ing knowledge of explosives, specifically detonating cords. Scene
photographs show a detonating cord attached to the torso and face.
No other devices were found.
External examination of the body revealed (Fig. 1) a well-
nourished man who was decapitated. The head showed multiple
irregular lacerations at the site of detachment. Examination of
the neck/torso showed irregular lacerations with peppering. There
were multiple, patterned, interrupted, semicircular abrasions around
the lacerations corresponding to where the detonation cord had been
wrapped around the head and neck (Fig. 2). On closer examination,
multiple orange-colored foreign body particulates, resembling
detonation cord, were found embedded within the neck wounds.
In addition to the direct tissue damage described above, the
oral mucosa showed stretch lacerations and broken teeth. Tympanic
membrane rupture was also present. These findings are in keeping
with primary blast injury/barotrauma. Multiple discrete abraded
contusions on the back of the right hand were also present, consis-
tent with initialization of the detonation at this site.
In addition to the tissue injuries, an electric wire was con-
nected to the neck with 2 additional wires running underneath
the sleeve of the right upper arm and forearm. These wires ended
with loops likely attached to a battery that acted as a detonating
device. Foreign bodies from the wound surface and swabs were
collected and sent for laboratory analysis.
A full-body computed tomography (CT) scan was completed
as per institutional protocol. The CT scan showed an elaborate net-
work of wiring around the head and neck area (Fig. 3, A and B).
Multiple fractures were identified in the cervical vertebrae. There
was no evidence of contusion injury to the brain.
The remainder of the CTexamination did not show other sig-
nificant abnormalities. Specifically, there was no evidence of lung

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Am J Forensic Med Pathol • Volume 40, Number 2, June 2019
FIGURE 1. External examination of the body.
and gastrointestinal tissue damage. There was no evidence of
hemorrhage and perforation of gas-filled organs, as would be ex-
pected in barotrauma associated with larger blasts. The findings,
or lack thereof, are more in keeping with direct injury caused by
detonation cord with generation of a small pressure wave, not
enough to cause large organ damage.
Histology showed heat effects on skin and soft tissue
(Fig. 4, A and B), acute hemorrhage, and embedded foreign
bodies within the wounds (Fig. 4, C and D).
DISCUSSION
Suicide by explosives is an uncommon but important sce-
nario. In addition to familiarizing themselves with the classic mac-
roscopic patterns of injury, every forensic pathologist should also
be able to skillfully assess patterns that deviate from the norm, es-
pecially when circumstantial information is not readily available.
It is important to remember that isolated explosion-related deaths
will present with the pattern of damage that is highly dependent on
the type, placement, and size of the explosive used. For example,
in our case, detonation cord was used. Detonation cord is thin, flexi-
ble hollow tube filled with explosive (Fig. 5). The most common
explosive used in detonation cord is “pentrite/PETN”; however,
other explosives can also be used. Detonation cords are designed
to have predictable explosion strength and rate of explosion per
unit of the cord length. These qualities make detonation cords a
commonly used tool, as a transmission medium for controlled ex-
plosions, in a variety of industrial settings such as precision glass
cutting, rock mining, and building demolition.6 Because of the in-
herent nature of detonation cord explosion, a large blast wave is
usually not generated, unless the cord is attached to a larger explosive.
Instead, the damage caused by detonation cord is more precise, direct,
and localized.
FIGURE 2. Close-up of detachment site.
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Suicide by a Detonating Cord
Furthermore, in addition to the type, size of explosive is also
important. Studies have shown in explosion-related suicides that
small explosive devices are more commonly used. In these cases,
the devices are strategically positioned closer to head and mouth
area to allow for maximal fatal damage.2 Furthermore, in the cases
of small explosives, the injuries are anatomically symmetric, reg-
ular, and localized. The tissue damage is mostly attributable to di-
rect explosive effect rather than barotrauma associated with large
pressure wave. In such cases, the classic internal organ injuries,
such as traumatic emphysema, air in body cavities, and perforation,
may be attenuated or completely absent. As a forensic pathologist,
one must be aware that the lack of widespread barotrauma-related
injuries should not exclude explosion-related death from the
differential. Thus, in addition to understanding the underlying
mechanisms of each type of explosion-related injuries, one must
remember that there is considerable variability in the injury pat-
terns observed as a result of the inherent properties of explosives
used. This knowledge can prove critical to a forensic pathologist
in order to make appropriate conclusions about the findings seen
at postmortem examination.
Taking it a step further, common patterns of tissue damage
seen in explosion-related deaths have been described by several
authors. Tsokos et al3 report that a careful examination of the lac-
erated edges of blast wounds shows bridging due to incomplete
separation of the underlying neural and vascular tissue. In another
article, Tsokos et al7 also reported a series of cases of decapitation
by various means. Bridging type of lacerations was seen in blast-
related injuries as well as decapitation resulting from trains.7 Marshall8
suggested either extensive localized damage or a triad of small bruises,
abrasions, and puncture lacerations is seen among the physical
examination findings resulting from primary explosive injury.
Although bridging, extensive localized damage, or “the triad”
is not pathognomonic for explosion-related injuries, they serve
as a useful sign in determining origin of injuries in combination
with scene information.
Taking histology samples in explosion-related deaths with
isolated primary blast injuries is also an important aspect of the
postmortem examination. It provides an opportunity to visualize
changes induced by the explosive at a microscopic level. Explo-
sions in open spaces cause less intense primary injuries because
the blast wave dissipates much more quickly than closed-space ex-
plosions.9 Eftaxiopoulou et al studied the effects of primary blast
injuries as a function of intensity and duration of the explosion in
a rodent-based model.1 They found that proinflammatory re-
sponse is dependent on the duration of exposure, not the intensity.
Neutrophils and monocytes are one of the first respondents in a pri-
mary blast injury and can be seen as early as 6 hours after exposure.
Thus, a histology specimen from a bomb blast victim whose tissue
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Khara and Herath Am J Forensic Med Pathol • Volume 40, Number 2, June 2019

FIGURE 3. Computed tomography scan of the head with elaborate network of wires.

shows neutrophils may hint toward a longer duration of blast expo-
sure. In addition to the inflammatory response, histological sections
are also helpful in assessing the extent of heat-related damage. De-
generation of epidermis, loss of attachment to the underlying dermis,
vacuolar cytoplasmic disintegration in the basal cell layer, and mi-
crovascular injury are seen in heat-related tissue injury.10
Furthermore, in cases where macroscopic or radiological ev-
idence of foreign body material is not present, microscopy may
play a critical role in identifying residual particles that have been
embedded in tissue at the site of primary blast injury. The micro-
scopic properties of the foreign body embedded within the tissue
can be analyzed and compared with microscopic properties of ma-
terials from explosive devices presumed to have been used. This
information can then be used to correlate with the environmental
factors or individual properties of explosive devices to draw edu-
cated conclusions about the scene. This can also serve as a great
opportunity for collaboration between forensic pathologists, fo-
rensic scientists, and forensic scene investigators.

FIGURE 4. A, Skin with heat effect (degeneration of the overlying epithelium and disruption of underlying dermis). B, Heat-related soft tissue
damage (cautery-like look with disruption of normal tissue architecture). C, Acute soft tissue hemorrhage and embedded foreign bodies. D,
Polarizable foreign body material.

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Am J Forensic Med Pathol • Volume 40, Number 2, June 2019
FIGURE 5. A, Detonation cord in decedent's trunk. B, Stock photograph of detonation cord.
Lastly, use of radiological studies such as radiographs and
CT scan can play dual role in explosion-related death investiga-
tions. These studies can aid in identification of the victims by pro-
viding information about medical devices or unique anatomical
variances.11 They can also provide critical information about the
extent of internal organ damage and highlight any foreign material
that may be of interest as evidence. Imaging studies are also crucial
to assess skeletal injuries in vertebrae and facial bones. Furthermore,
postmortem imaging can prove to be especially important in the
cases where evidence of explosives has been concealed, both for
evidence collection and for the safety of all personnel involved.12
In conclusion, explosion-related death investigations can be
challenging for forensic pathologists. First step in any such case
should be to develop a basic framework that can aid in interpreta-
tion of findings. Knowledge of different types explosion-related
injury patterns and their relative distribution as a function of type,
duration, placement, and size of explosives is crucial. It is critical
to realize that explosion-related damage can be quite anatomically
localized. In such cases, a closer examination of tissue damage is
helpful, especially if tissue bridging, localized lacerations, and
abrasions are seen. Furthermore, embedded foreign body particles
and soot particles can also be helpful. Histological evaluation of
tissue damage with heat-related damage and embedded explosive
particulate are also helpful hints that the death has been caused by
an explosive. Lastly, a complete death investigation including
proper history and circumstances analysis, use of ancillary studies
such as radiographs and CT scan, collection and analysis of evidence,
thorough postmortem examination, and other laboratory investi-
gations are necessary for a forensic pathologist to provide proper
opinion including interpretation of findings and reconstruction of
the event.
ACKNOWLEDGMENT
The authors thank Dawn Thorpe, imaging technologist, for
providing them with 3-dimensional reconstruction images.
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Suicide by a Detonating Cord
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