Background and aims: Medico-legal autopsy cases are necessary to interpret the cause of death, and the retrospective study and analysis of such autopsy reports are necessary to understand the prevalence of the cause of death and to initiate corrective measures to prevent avoidable casualties in future, by conducting lifestyle and mental awareness amongst the different communities, schools and colleges. Methods: This is a 17-year retrospective study of all autopsies conducted at the Mortuary, STNM Hospital, Sikkim, Gangtok, India, from 2006 to 2022. Results: Of the total 2,574 cases, the male-to-female ratio was 3.3:1. The males exhibited a pronounced prevalence, and most cases were within the age group of 21–30 age group, where 695 cases were recorded, with 543 males and 152 females. It was observed that February was the month with the fewest autopsies, while October witnessed the highest number of autopsies. Hanging with male preponderance was the most prevalent manner of death (29.99%), followed closely by fatalities resulting from falls from heights (13.20%) and sudden deaths (12.62%). Further analysis of the autopsy data to understand the trend indicated a noteworthy upward trajectory, notably escalating from 2006 to 2022. While 2007 witnessed a substantial decline in autopsy numbers, subsequent years showed a steady resurgence, peaking in 2010. Conclusion: This study provides valuable insights into the demographics, patterns, and common causes of death in Sikkim, offering a foundation for informed strategies in forensic medicine and public health initiatives.

Keywords: Medico-legal autopsies; cause of deaths; manner of deaths; sudden death.