Medico-Legal Autopsy Notes

Autopsy Definitions

• Autopsy: Self-viewing
• Necropsy: Dead-viewing
• Post-mortem examination: After death

Types of Autopsies

• Based on Objectives:
  • Clinical/Pathological Autopsy
  • Medico-legal Autopsy
• Based on Material:
  • Adult
  • Fetus
  • Skeletal Remains

Clinical vs. Medico-legal Autopsy

• Identity:
  • Medico-legal: Frequently in question
  • Clinical: Always known
• Nature of Death:
  • Medico-legal: Sudden, suspicious, unexpected, litigious, or unnatural
  • Clinical: Natural death
• Need:
  • Medico-legal: Administration of justice
  • Clinical: Evaluate effect of treatment for patient care improvement
• Objective:
  • Medico-legal: Determine cause and manner of death
  • Clinical: Determine mechanism of death
• Consent:
  • Medico-legal: Kin's permission not required
  • Clinical: Kin's permission required
• Extent:
  • Medico-legal: Complete autopsy (all cavities)
  • Clinical: Autopsy of area with known complications
• Chemical Analysis:
  • Medico-legal: Frequently done
  • Clinical: Not done
• Histopathology:
  • Medico-legal: Always done
  • Clinical: Done for confirmation
• Conducted By:
  • Medico-legal: Forensic expert
  • Clinical: Pathologist
• Confidentiality:
  • Medico-legal: Public record
  • Clinical: Confidentiality applies

Rules & Regulations for Medico-Legal Autopsy

• Authorization by Police or Magistrate required.
• Perform without delay.
• Establish identity before autopsy.
• Unauthorized persons not allowed.
• Preferably done in natural daylight.
• Complete autopsy required; partial unacceptable.
• Findings are confidential.

Objectives of Medico-Legal Autopsy

• Who: Identification of the deceased.
• What: Cause of death.
• How: Manner of death (suicidal, accidental, or homicidal).
• When: Time of death.
• Where: Place of death.

External Examination

• Clothing and accessories
• General description of the body
• Natural orifices
• Eyes and Oral cavity
• Postmortem changes
• Injuries

Skin Incisions in Medico-Legal Autopsy

• 'I' Shaped Incision: Symphysis menti to pubic symphysis, avoiding umbilicus.
• 'Y' Shaped Incision: Mastoid bone to supra-sternal notch, then down to pubic symphysis; suited for detailed neck study.
• Modified 'Y' Shaped Incision: Acromion process, curving under breasts to xiphisternum, then down to pubic symphysis; cosmetic purposes.
• 'X' Shaped Incision: Back and limbs; detects subcutaneous hemorrhages.

Techniques of Evisceration

• Virchow: Individual organ removal.
• Rokitansky: Organ dissection in-situ.
• Letulle: En-masse dissection & organ separation.
• Ghon: Separate block dissection & organ separation.

Dissection of Heart

• Method: Inflow-outflow method (direction of blood flow).
• Procedure:
  • Open pericardial sac.
  • Separate heart from vessels.
  • Cut open right atrium, right ventricle, left atrium, left ventricle.
  • Check patency of coronary arteries.

Scalp Incision

• Coronal Incision (Bi-Mastoid Incision): Scalp incision from one mastoid to the other.
• Skull Cap: 'V' shaped sawing of skull vault

Bloodless Dissection of Neck

• Indications: Deaths due to pressure over neck structures (hanging, strangulation, etc.).
• Purpose: Avoid artifacts from blood seepage; document injuries.

Negative Autopsy

• An autopsy without positive findings that fails to reveal the cause of death despite investigations.

Obscure Autopsy

• A complete autopsy with trivial/unclear findings that fails to ascertain the cause of death.
• Concealed trauma
• Cardiac lesions
• Reflex Vagal inhibition

Preservation of Viscera/Body Fluids for Chemical Analysis

• Routine Preservation:
  • Stomach with contents
  • Small bowel
  • Liver with gall bladder
  • Kidneys
  • Urine
  • Blood (Femoral Vein)
• Preservatives: Saturated Sodium Chloride, Sodium fluoride
• Special Cases:
  • Narcotic drugs/cyanide/strychnine: Brain
  • Alcohol: C.S.F / Vitreous Humor
  • Cardiac poisons: Heart
  • Heavy metals: Long bone, hair, nail
  • Snake bite: Skin/muscle from site and control
  • Pesticides/anesthetic agents: Fatty tissue