Hidden ballistic injury and fall from height: An unusual complex suicide and review of the literature

In France, firearm suicide is the second most common method among men, after hanging. Complex suicides, which involve multiple methods, are rare but significant. Forensic investigations are essential for determining the sequence of events and whether methods were used simultaneously or if one followed the failure of another. Ballistic suicides are frequently associated with hanging. This case report details a rare unplanned complex suicide involving a cranioencephalic ballistic injury followed by fall from height in a 56-year-old man. He was discovered deceased beneath his building. Autopsy revealed a non-fatal and non-incapacitating ballistic injury, confirmed by X-ray, in contrast to the severe traumatic injuries sustained from the fall, which were lethal. This specific combination of methods is rarely reported in literature. Analyzing the sequence and vitality of each injury is essential to rule out potential criminal acts. • Rare unplanned complex suicide: firearm injury followed by fall from height • Unusual non-lethal black powder shot with distinct wound features • Vitality and injury sequence must be assessed with precision • Detailed investigation avoids crime scene misclassification