Evisceration Techniques & Autopsy Procedures

What information is recorded when a body arrives at the morgue?

Name

Date/time of arrival

Transport personnel

Receiving personnel

Case number

Identification photograph with case number

Where is the ligament of Treitz located?

Extends from the diaphragm to a part of the small intestine called the duodenojejunal junction

Why is chain of custody important?

Maintains legal integrity of:

• Evidence

• Toxicology specimens

• Personal belongings

• Documentation

Breaks in chain of custody may compromise criminal investigations.

What should NOT occur before pathologist examination?

The following actions may destroy evidence:

• Washing

• Embalming

• Undressing

• Fingerprinting

Why are x-rays obtained before autopsy?

To identify:

• Bullets/projectiles

• Fractures

• Medical devices

• Foreign bodies

What laboratory studies are commonly ordered during medicolegal autopsy?

Toxicology

Histology

Neuropathology

Microbiology

Serology

What is the purpose of the Y-incision?

To provide access to the:

• Neck

• Thoracic cavity

• Abdominal cavity

while preserving cosmetic reconstruction

What structures become accessible following a Y-incision?

Cervical organs

Thoracic organs

Abdominal organs

When may the Y-incision be modified?

During specialized neck dissections or trauma investigations where extension to the ears is required

What should be assessed immediately upon entering the thoracic or abdominal cavity?

Blood

Fluid

Pus

Chyle

Air

Adhesions

Organ position

What pulmonary finding should always be evaluated before lung dissection?

Pulmonary thromboemboli

Why is the common bile duct probed during autopsy?

To evaluate:

• Patency

• Gallstones

• Obstruction

What should be assessed when examining the aorta?

Aneurysm

Dissection

Thrombi

Calcifications

Rupture

What are common causes of abnormal body cavity fluid?

Hemoperitoneum

Hemothorax

Ascites

Empyema

Chylous effusions

What is the Letulle method?

Removal of all organs as one organ block (en masse)

Most common method in hospitals

What is the Virchow method?

Removal of organs one at a time

What is the Ghon method?

Removal of organs in regional organ blocks

What is the Rokitansky method?

In situ dissection with little or no organ removal

Major advantage of Letulle?

Preserves organ relationships

Greater safety

Most dissection occurs outside body cavity

Rapid body reconstruction

Major disadvantage of Letulle?

Organ examination takes longer

Often requires assistance

Major advantage of Virchow?

Easier for forensic autopsies

Highlights individual organ pathology

Technically straightforward

Major disadvantage of Virchow?

Loss of organ relationships

Major advantage of Ghon?

Easier for one person

Preserves regional anatomy

What pathology may be compromised by Ghon?

• Aortic dissection

• Aneurysm

• Esophageal varices

• Esophageal neoplasms

because structures are transected at the diaphragm

Major advantage of Rokitansky?

Fast

Useful in restricted-consent autopsies

Major disadvantage of Rokitansky?

Blind dissection

No organ block removal

Limited evaluation

Which method is most useful for preserving disease relationships among organ systems?

Letulle

Which method is most commonly adapted for forensic autopsies?

Virchow

How are lungs examined?

Examine for thomboemboli

Weigh

Inspect pleura

Palpate parenchyma

Inflate with formalin

Section at 1–2 cm intervals

Examine parenchyma

Examine airways

Why inflate lungs with formalin?

Preserves alveolar architecture

How are coronary arteries evaluated?

Cross-sections every 2–3 mm

Why are papillary muscles sectioned longitudinally?

To detect infarcts

What cardiac measurements are routinely obtained?

Heart weight

Ventricular wall thickness

Valve circumference

How are kidneys sectioned?

Coronal bivalving

What structures are evaluated in the kidney?

Cortex

Medulla

Pelvis

Pyramids

How thick should liver slices be?

≤1.5 cm

Along which border is bowel opened?

Antimesenteric border

What prostate region is best for histology?

Area near the seminal colliculus

What measurements should be recorded for the uterus?

Cavity dimensions

Endometrial thickness

What are characteristics of antemortem thrombi?

Soft

Friable

Dark red

Adherent

What are characteristics of postmortem clots?

Elastic

Gelatinous

Yellow-red layering

"Chicken fat" appearance

Non-adherent

Why is clot distinction important?

Antemortem thrombi may indicate a disease process contributing to death, while postmortem clots are artifacts

Why is the posterior skull cut higher than the anterior skull?

Facilitates reconstruction and supports the cerebellum

What structures are cut to free the brain?

Cranial nerves

Vertebral arteries

Medulla/upper cervical cord

When should the brain be examined fresh?

Suspected subarachnoid hemorrhage

How is the cerebrum sectioned?

Coronal sections every 0.5 cm

How is the spinal cord removed?

Cut vertebral processes

Open dura

Transect nerve roots

Remove cord inferior → superior

Why is fixation critical before brain dissection?

Prevents distortion and improves evaluation of subtle lesions

What vascular structure must always be evaluated at the brain base?

Circle of Willis

Which cranial nerves should be identified during brain examination?

Cranial nerves I–IX when possible

What ventricular abnormality may be identified on coronal sectioning?

Hydrocephalus

Why is the Circle of Willis examined?

Common location for berry aneurysms causing subarachnoid hemorrhage

Which muscles are commonly sampled for neuromuscular disease?

Quadriceps

Gastrocnemius

Which peripheral nerve is most commonly sampled?

Sural nerve

Why are muscle samples stretched on stiff paper before fixation?

To preserve fiber orientation and prevent contraction artifact

When should eyes be examined?

To examine for:

• Ocular disease

• Neurologic disease

• Systemic disease affecting the eye

How long are eyes fixed before dissection?

24–48 hours

Rinse

Store in 70% alcohol

What are the indications for middle ear examination?

Meningitis

Otitis media

Deafness

Vestibular disease

Which sinus contains the sella turcica region?

Sphenoid sinus

What are the indications for complete neck dissection?

Cervical trauma

Upper airway obstruction

Tongue tumors

Suspected strangulation or hanging

Where is the thoracic duct located?

Between the azygos vein and thoracic aorta

Which joints are commonly examined at autopsy?

Knee

Shoulder

Sternoclavicular

Intervertebral joints

What should be done if the globe collapses during fixation?

Inject alcohol into the globe before dissection

Why is prolonged fixation important for the eye?

Maintains globe shape and preserves delicate retinal and intraocular structures

How is the middle ear exposed during autopsy?

Using an oscillating saw, four cuts are made through the petrous temporal bone:

1. Near the apex of the petrous bone

2. Parallel through the mastoid region

3. Vertical cut joining anterior ends

4. Horizontal cut joining posterior ends

This removes a block containing the middle ear structures

What anatomic structure houses the middle ear?

Petrous portion of the temporal bone

How is the frontal sinus examined?

Carefully cut through the frontal bone to expose the sinus

How is the sphenoid sinus examined?

Remove a cube of bone to examine the:

• Sella turcica

• Cavernous sinus

• Sphenoid sinus

• Intraosseous carotid arteries

How is the maxillary sinus accessed?

Create a small bony opening through the upper gum posterior to the canine teeth

Why is the sphenoid sinus region especially important?

It contains the pituitary gland and cavernous sinus and is closely associated with the internal carotid arteries

How is the neck dissection initiated?

Extend the Y-incision superiorly toward the ears

Why must cervical trauma be preserved during dissection?

To distinguish true antemortem injury from autopsy artifact

What structures are specifically examined during cervical spine dissection?

Cervical muscles

Vertebral arteries

Cervical vertebrae

Neural foramina

Which structures are commonly fractured in manual strangulation?

Hyoid bone

Thyroid cartilage

What is the cisterna chyli?

A dilated lymphatic sac that continues superiorly as the thoracic duct

Why should the thoracic duct be identified before evisceration?

It may be damaged during organ removal and become difficult to locate afterward.

How is the thoracic duct identified from the right side?

Lift the right lung and locate the duct:

• Anterior to thoracic vertebrae

• Left of azygos vein

• Right of thoracic aorta

How is the thoracic duct identified from the left side?

Retract left lung

Transect intercostal arteries

Reflect aorta rightward

Identify duct in retroaortic fat

What fluid is carried by the thoracic duct?

Chyle (lymph rich in absorbed dietary fat)

When are bones and joints specifically examined at autopsy?

Evaluation of systemic joint diseases or musculoskeletal pathology

Which joints are most easily accessible during autopsy?

Intervertebral joints

Sternoclavicular joints

Shoulder joints

How is the knee joint examined?

1. Curved incision below the patella

2. Flex the knee

3. Incise quadriceps tendon

4. Open joint cavity

5. Inspect articular surfaces and soft tissues

What structures should be sampled from the knee?

Articular cartilage

Joint capsule

Bursae

Tendons

How can the entire knee be removed?

Through an anteromedial incision

What are the primary goals of a medicolegal autopsy?

Determine cause of death

Determine manner of death

Document injuries

Identify contributing factors

Exclude alternative causes of death

Collect evidence for legal investigation

Do all medicolegal cases require a complete autopsy?

No — The extent varies by case, although all homicides require an autopsy

• Some cases may undergo limited examination depending on circumstances

What structures are minimally examined in a complete forensic autopsy?

Brain

Larynx w/ hyoid bone

Thoracic and abdominal organs (EVERYTHING)

Blood

Urine

Bile

Vitreous fluid (when available)

Why is vitreous fluid collected during autopsy?

Useful for:

• Electrolyte analysis

• Glucose evaluation

• Ketone testing

• Estimation of postmortem biochemical abnormalities

What photographs should be taken of wounds?

Overall view showing wound relative to landmarks

Close-up image

Scale ruler

Case identification number

Color ruler if color assessment is important

How should the heart be weighed?

After removing blood clots and trimming great vessels approximately 1 cm above valves

Why are abnormal fluids important during autopsy?

They may indicate:

• Hemorrhage

• Infection

• Heart failure

• Trauma

• Malignancy

Analyzing their volume, color, and composition

What is the sequence of evidence collection during external examination?

1. X-rays

2. Recover trace evidence

3. Remove clothing

4. Photograph body

5. Clean body

6. Re-examine for injuries

How should the heart be cut?

In the direction of blood flow

How is the stomach opened during autopsy?

Along the greater curvature through the pylorus into the duodenum to expose the ampulla of Vater

What structures are evaluated in the biliary tract?

Common bile duct

Hepatic ducts

Cystic duct

Gallbladder

Why are structures evaluated in the biliary tract?

Assess for:

• Calculi

• Patency

• Obstruction

How is the pancreas sectioned?

Serial parasagittal sections perpendicular to the long axis