PostMortem Examination Necropsy a small walkthrough

Dr.S.ValliappanPG JR,Dept of Forensic Medicine & Toxicology GMCH 32,CHANDIGARH.

The Search For Hidden Truths

Introduction

What is postmortem examination

•Post-mortem (meaning after death)examination refers to an examination and dissection of a dead body to determine cause of death or the changes produced by disease.

•Post-mortem is also called as autopsy and necropsy.

•But the term “autopsy”(Greek autos –self, opis –view) means “to see for oneself”, it’s a misnomer which is commonly used,and the term “Necropsy”(Greek ,necro –dead, opis-view).

History of Autopsy

• More than 1800 years ago, GALEN (129-201 AD),did for first time dissection on animals and primates.

• Fredrick II (1194-1250) authorised human dissection,

• Rudolph Virchow (1821-1902) founder of modern pathology,

History of Autopsy in India

• Dr. Edward Bulkely performed ,he first documented medico- legal autopsy in 1693 in Chennai.

• Dr.Edward Bulkely first corner appointed by British,

• 1882 first medical autopsy was conducted at Grant medical college, Byculla Mumbai.

Types of Necropsy

• Academic Autopsy,

• Pathological, hospital or clinical Autopsy,

• Medico-legal Autopsies: –• Usually done in unnatural death, sudden death and in

case of suspicious death.

• Are carried out by RMP in government hopitals, Forensic experts(Police Surgeon) in request to IO(Investigating Officer).

Objectives of Autopsy

• To establish identify of the deceased body.

• To find out the Cause of Death i.e. Natural or Unnatural.• Whether death is Homicidal, Suicidal or Accidental.

• To ascertain Time passed since death.

• To asses the weapon used,

• To collect trace evidence, physical evidence &viscera for chemical and HPE.

• Whether still-birth or live-birth of newly born infant

• • THE ONLY THING WORSE THAN NO AUTOPSY, • IS A PARTIAL AUTOPSY

• SO,IN EVERY CASE,THE AUTOPSY MUST BE • COMPLETE

Prerequisite for Necropsy

• Written order from the Investing Police Officer.

• Day light• Place: In the Hospital

• Where the dead body lies

• Identity of the deceased to be established

No unauthorised person should present will doing autopsy.

Contents of Post-Mortem Report

• Name of the deceased,

• Identification,

• Place, date and time of post-mortem,

• External Examination, Internal Examination• Viscera and Samples collected for analysis

• Opinion as to cause and manner of death

Instruments & Accessories for Autopsy

Stryker Saw:good for cutting into skull

Equipment

• Waist high and is plumbed for running water and has several faucets for washing away blood that is released during the procedure. Raised edges keep blood and fluids from running into the floor.

Body Block

Placed under the back of the body causing arms and neck to fall back while pushing the chest upward to make it easier to cut open.

Cadaver Table

General Examination

• Body is weighed, measured and X-rayed• Photographs are taken of the body (front, back & naked)• Fingerprints are taken (if any missing, parts are noted)• Scrape underneath fingernails for evidence • Examination of clothes • Age, sex and race are noted• Eye color, scars, venesection wound, tracheostomy

wound ,moles, tattoos are noted• Examination of the eyes (blood spots & etc.) • Any body secretions and gun powder residue/ bullet holes• Body fluids are drawn from the body for testing (blood, urine,

spinal fluid, vitreous humour from the eye • Body is cleaned and ready to be put on table

• External Examination of Natural OrificesFor foreign bodies, injuries, discharges (blood/pus, froth)

• External ExaminationPresence of Teeth/Dentures

• Various dental work• External Examination of Marks

Cord,ligature markFinger marks round the neckIts exact position,MannerApplication of the knot

External Examination to Ascertain Time Passed Since Death

• Rectal Temperature- . ALGOR MORTIS .

• Hypostasis- . LIVOR MORTIS.

• RIGOR MORTIS.

• Stage of Putrefaction.

• Ova of flies and maggots

External Examination of Injuries

• From head to foot& from front to back• Injury: Situation (Position)• Extent• Nature (Contusion, Abrasion,

Lacerated, Incised, Stabbed or Punctured)• Dimension• Condition of Edges• Course and direction of bullet• Direction of blood smear

External Examination Types of Injuries

• Contusion• Abrasion• Laceration• Incised Wound• Punctured/Stabbed wound• Burns:-

First Degree Second Degree Third Degree

Internal examination

Types of incision for internal examination:• 1. “I” shaped incision: this incision is mostly used

nowadays, it extends from symphysis menti at the beginning to symphsis pubis at end.

• • 2.”y” shaped incision: these incisions are usually made

in female deceased body, for cosmetic purpose .it extends from acromion process on both sides, runs below the breast and reaches pubic symphysis.

• 3.”modified y” incision :usually done in case of hanging or strangulation, where neck dissection is important.

Y incisions

Internal examination

• Internal Examination of Body:•

Order of Exam:•

Abdomen Thorax Head

• But this order of examination is also can be changed, its based on

medical officer decision.

Internal examination

• Different types of organ removal:

• 1.Virchows method-removal of single organ one by one

2.Rokitansky method-in situ dissection

3.Letulles method-en masse removal

4.Ghons method-en block removal

Internal Examination of Thorax

• Split the ribcage, open it up, and examine the lungs and heart, note any abnormalities, and take a second blood sample directly from the heart.– Ribs Fracture– Sternum fracture

• Pleural Cavities- for blood, fluidLungs- Collapsed, Full, Water

Internal Examination of Thorax

• Pericardium• Heart• Chambers of Heart• Coronary Arteries• Aorta,• Larynx,• Trachea,• Oesophagus

Examination of Heart

• Evaluation of coronaries:

• -Before any forms of cardiac dissection is applied, coronaries should be inspected for calcification and tortuosity.

• -Subjects younger than 30yrs or where cause of death is

non cardiac: coronaries may be opened longitudinally

• -Otherwise, transverse section : 3.5-5mm .

• -Calcified vessels are stripped off and decalcified

• Air embolism in heart chambers should be also checked.

Cardiac Dissection

• Inflow-outflow method:• Right: -Using entrotome, initial cut is made from IVC to right atrial

appendage sparing SVC and SA node.• -Right ventricle opened with knife along 1cm

parallel to the posterior ventricular septum• -Outflow tract :1cm parallel to anterior

ventricular septum• Left: -Left atrium-between R and L pulmonary veins• -Left atrial appendage checked for mural

thrombus.• -Inflow tract: left ventricle opened along its

inferolateral border.• -Outflow tract :to avoid damage to mitral valve, 1cm

parallel to anterior ventricular septal groove

Internal Examination of Abdomen

• Peritoneum• Abdominal Cavity• Abdominal Organs• Pelvic Cavity• Stomach• Small and Large Intestine• Liver,• Gall bladder

Internal Examination of Abdomen

• PancreasSpleenKidneys

• For Necrosis• Size, Colour Weight,• Rupture, Calculi• Bladder

ProstateTestes

• Spinal cord ,• Vertebral column ,• Pelvis

INTERNAL EXAMINATION BRAIN CAVITIES

• After the main organs are examined the examiner proceeds to the brain; (The body block is then moved to underneath the head)

• Next, examine the head. Check for any trauma to the skull like fractures or bruises

• Deep incision begins behind one ear, travels over the top of the head and behind the opposite ear.

• The scalp is pulled away from the skull in two flaps; front going over the face and the rear going over the back of the neck so the skull is fully exposed.

• Electric saw known as the “ Stryker saw” is used to cut and remove a wedge shape portion of the skull which exposes the brain.

• Brain is removed, weighed • and examined. • Any findings noted

Internal Examination Brain Cavities

• Once everything has been examined, all the internal organs are returned to the body cavities or

incinerated. • The body is sewn back together A report will be done based on notes and findings while performing the

autopsy• Send tissue samples, blood, urine & etc. to lab for testing• Refrigerate body to preserve it until its ready to be moved elsewhere

Post-Mortem Reports Value

• Provides information about cause of death,• Statement of the Medical Officer made in Court is

substantive evidence• Medical Officer can use it for refreshing his

memory while giving evidence• For Corroboration & Contradiction of Medical

OfficerReserving Opinion as to the cause of deathpending result of chemical analysis.

• Negative Autopsy• Obscure autopsy.

Thank you….