External Examination — it is the most important part of the medicolegal autopsy procedure, as most of the information gathered at this stage can always help a lot in solving the most mysterious deaths. This includes examination of:
Internal Examination: This includes dissection and examination of the three major body cavities and their contents, namely:
Technique of R. Virchow: %%Organs are removed one by one%%.
Technique of C. Rokitansky: This is characterized by ‘%%in situ’ dissection%%, in part, combined with removal of organ blocks.
Technique of A. Ghon: %%Thoracic and cervical organs, abdominal organs, and the urogenital systems%% are removed or organ block.
Technique of M. Letulle: %%Cervical, thoracic, abdominal and pelvic organs are removed%% as one organ mass and subsequently dissected into organ blocks.
I-Shaped Incision: Extends from symphysis menti to symphysis pubis taking curve towards left around umbilicus.
Y-Shaped Incision: Commence at angle of mandible above on either side and the incision from both sides brought forwards, downwards to meet at the suprasternal notch and then run downwards as in “I” shape incision to symphysis pubis.
Modified Y-Shaped Incision: Commences at anterior axillary fold on the chest on either side, runs downwards and anteriorly beneath the breasts as to meet at xiphisternum in the midline and then run downwards as in I-shaped incision to symphysis pubis.
Elongated X-shaped Incision: This is special incision used to dissect out subcutaneous structures in the back to identify and evaluate the extent of blunt injuries, which are usually missed where superficial imprints are faint, particularly when present on skin not overlying bone.
The rectus abdominis muscle is incised first and then a small nick is made into the peritoneum.
Next, introduce the index and middle fingers of left hand into the peritoneal cavity.
As the abdominal cavity is opened look for following:
The skin, subcutaneous and soft tissues in the neck and chest are then reflected sideward.
Now, cut along the costochondral junction, and reflect the chest plate.
Introduce the hands into pleural cavities and explore and look for blood/fluid collection.
Disarticulate the sternoclavicular joints on either side, cut the cartilage of first rib and separate the chest plate and remove it.
Examine the mediastinum for injuries and other findings and notice accordingly.
Now, cut the tissue of the floor of the mouth along inner sides of lower jaw with tip of a long pointed knife and release the attachments of tongue.
Pull-down the tongue and cut behind the pharynx and larynx and release the attachments from vertebral column.
Cut the costocervical fascia and large blood vessels at the root of the neck.
Hold the tongue with a piece of cloth wound around it and trachea and by applying gentle traction, pull-down the thoracic organs caudally.
Cut the crux and attachments of diaphragm muscle and pull further caudally.
Pull-down further and remove all the organs en masse from the abdomen.
Keep the ‘en masse’ viscera thus removed on a dissection table in a prone position and cut open the aorta from below upwards starting at little above its bifurcation, up to the arch of aorta.
Each of the viscera is then removed and examined separately grossly and on sectioning, weight of each of the organs being measured before its dissection, except heart, which is weighed after the dissection.
The stomach is first removed by cutting between
ligatures at its cardiac and duodenal ends, and cut open along greater curvature studying the contents and changes of the wall. Smell the contents for any abnormal odor.
Heart is dissected in the direction of blood flow and is discussed separately.
Uterus with appendages must be removed ‘en block’ through abdominal incision, and dissected separately, noting the changes, especially the products of conception (fetus), presence of foreign body, tumor, or signs of delivery, criminal abortion, etc. prior to its sectioning.
To begin with, pass a forceps through the openings of superior and inferior vena cava and by cutting between the arms of forceps, open the right atrium. Open also the auricular appendage and look for the thrombi, if any.
Now, introduce two fingers into the right ventricle through the tricuspid valve and assess its size. Next, introduce a long pointed knife through it and pierce the apex and cut along the right lateral margin in one stroke.
Next, from the apex cut open the pulmonary artery, along its long axis and examine the valve, cusps and look for the presence of any embolus.
Then, pass the scissors into pulmonary veins, jointly cut them and enter into the left atrium. Cut the left auricular appendage and look for the thrombus, if any.
Introduce fingers into mitral valve and examine it (normally two fingers allowed). Now introduce the tip of a sharp pointed knife into mitral valve and pierce through the apex and cut along left lateral margin in one stroke
Examine the wall, valves, papillary muscles, chordae tendineae, septum, etc.
Next, open the aorta from the left ventricle and examine the aortic valve and coronary ostia. Pour a thin stream of water into these leaflets of the valves from a tap and confirm their intactness.
Coronaries are dissected longitudinally or by serial sectioning along their course for their patency.
Obscure autopsy — an autopsy %%done meticulously, properly and perfectly, but may present with no clear-cut findings%% as to give a definite cause of death, leading to perplexity of the forensic pathologist.
Causes:
Interviews with eyewitnesses: These interviews are usually conducted with persons who witnessed the actual death event and/or persons who found the deceased’s body.
Interview with character witnesses: These are persons who were related to, or acquainted with, the deceased in some or other way, such as family, friends and co-workers
Physical autopsy of the corpse: According to psychologists there is a third interview, which involves a physical autopsy of the corpse. Quite often, the dead will reveal hidden secrets about themselves or others of which no witnesses were aware.
The procedures of psychological autopsy in suicide cases are aimed at the production of four outcomes:
Clinical History:
Clinical conditions or findings: