Autopsy

Autopsy: Types, Objectives, Law, Techniques

Introduction

• Speaker: Dr. Ajith Tennakoon

  • Qualifications: MD-Hon(USSR), MD, DLM (SL), Dip. RCPA (Aus), MFFLM (UK), FFCFM(RCPA)

  • Position: Specialist in Forensic Medicine, Head of Forensic Medicine Unit, General Sir John Kotelawala Defence University

  • Previous Role: Chief Consultant Judicial Medical Officer, Colombo

Definition of Autopsy

• Also known as:

  • Post Mortem Examination

  • Necropsy

• Purpose:

  • Legal

  • Medical

• Description:

  • A thorough examination, dissection, and investigation of a dead human body.

Conductors of Autopsy

• Performed by:

  • Medical Doctor

  • General Pathologist

  • Forensic Pathologist

  • Judicial Medical Officer (JMO) in Sri Lanka:

  • Consultant Judicial Medical Officer (Specialist in Forensic Medicine)

  • Assistant JMO

  • Medical Officer-Medico Legal (MO-ML)

Types of Autopsies

1. Medico-legal Autopsy

• Also referred to as forensic or coroner's autopsies.

• Performed under legal guidelines, specifically in Sri Lanka's Code of Criminal Procedure, Chapter XXX.

• Conducted by:

  • JMO in Sri Lanka

  • Forensic Pathologist

  • Medical Examiner

2. Clinical or Pathological Autopsy

• Purpose:

  • Diagnose diseases or conduct research or academic purposes.

• Context in Sri Lanka:

  • Done for hospital deaths

  • Cause of death must be known

  • Requires consent from next of kin/relatives

  • Death declaration form (B-33) is mandatory

  • Conducted by clinician/general pathologist/JMO

  • Not applicable for community deaths

3. Anatomical or Academic Autopsy

• Purpose:

  • Conducted by students of anatomy for study purposes

4. Virtual or Medical Imaging Autopsy

• Technique:

  • Utilizes imaging technology, primarily MRI and CT scans.

• Usage varies by country:

  • Employed as a screening process

  • Alternatives when consent for traditional autopsy is not granted

Judicial Autopsy

• Please note the following procedures:

  • Notification of police is required (applicable for both hospital and community deaths)

  • Police inform the Investigating Sub-Department (ISD)/Magistrate

  • An inquiry will be held

  • ISD/Magistrate requests the JMO to conduct the autopsy and send the report

  • Relatives must identify the body in the mortuary

  • JMO may visit the crime scene, if relevant

  • Meetings with relatives and police before and post-autopsy are necessary

  • Notably, consent of the next of kin is not necessary in Sri Lanka

Objectives of the Judicial Autopsy

• Identification of the deceased

• Determining the cause of death

• Analysis of types of injuries

• Identifying weapons that caused those injuries

• Assessing what injuries may have caused death

• Examining voluntary activities post-injury

• Determining time lapsed between injury and death

• Assessing time since death

• Identifying factors contributing to death

• Evaluating possible consumption of alcohol and addictive drugs

• Confirming if the location of death aligns with where the body was found

• Investigating the circumstances of death

• Gathering clues to identify possible suspects

• Collecting trace evidence for perpetrator identification

• Reconstructing the incident using medical evidence

• Retaining samples for ancillary investigations and forwarding to appropriate agencies

• Addressing relevant medico-legal issues

• Properly managing the body handover to relatives

• Preparing post-mortem reports for court submissions, initial cause of death available via Health:1328 uniform form

• Time-efficient final autopsy report generation

• Respectful handling of cases, especially mass disasters and unidentified deceased

• Providing unbiased opinions in suspected medical negligence incidents

Special Considerations for Road Traffic Accidents

• Reconstruction of the incident via medical evidence

• Investigating trace materials to identify vehicles involved in “hit and run” cases

• Determining the victim's position during the accident

• Evaluating use of alcohol or other substances

• Identifying contributing natural diseases

Steps of Performing an Autopsy

• Comprehensive procedures:

  • Scene examination

  • Examination of clothing and personal objects

  • External examination of the body

  • Dissection:

  • Opening all body cavities

  • Dissection of all organs

  • Ancillary investigations including but not limited to:

    • Histopathology

    • Virology/bacteriology/serology/immunology

    • Toxicology

  • Body reconstruction

  • Handover of the body to relatives

External Examination Details

• Assessment of physical observations:

  • Height, weight, nutritional status

  • Signs of death

  • Presence of injuries, deformities, scars, tattoos

  • Evidence of natural diseases

  • Evidence indicating unnatural circumstances of death

  • Collection of samples for ancillary investigations, including swabs, blood, saliva for foreign DNA

Handover of the Body

• Essential principles:

  • Dignity and respect for the deceased

  • Consideration for the emotional state of next of kin

  • Psychological support particularly vital in cases like mass disasters and child deaths

  • Need for empathy during the process

Autopsy Room Requirements

• Essentials for proper functionality:

  • Well-lit room

  • Firm stainless steel autopsy tables

  • Infrastructure for running water

  • Availability of autopsy instruments

  • Wooden block for neck support

  • High standards of cleanliness

  • Accident prevention measures

  • Care in handling autopsy instruments

Various Instruments Used in Autopsy

Examples include:

• Hagedorn needle

• Skull chisel

• Rib cutters

• Scalpel

• Toothed scissors

• Bone saw

Incision Techniques

Common Autopsy Incisions

1. I-shaped incision

   • Starting from the chin down to the pubic symphysis

   • Most commonly used incision

2. Y-shaped incision

   • Starts from the shoulders, reaches xiphisternum, then down to pubic symphysis

3. Modified Y-shaped incision

   • Begins from mastoid, goes down lateral neck, and from suprasternal notch to pubic symphysis

   • Used specifically for neck dissection

Organ Removal Techniques

1. Virchow’s Method

   • One-by-one removal of organs

2. Letulle’s / En Mass Method

   • Evisceration for a rapid study of anatomical relations

   • All thoraco-abdominal organs removed in one piece

3. Ghon’s Method

   • En-bloc removal, focusing on a specific area (e.g., pelvic or thoracic organs)

4. Rokitansky Method

   • In-situ method to avoid spillage and cross-exposure, useful for managing infectious diseases (e.g., HIV, Hepatitis, Covid)

Special Neck Dissection Techniques

• Princeloo-Gordon technique designed for suspected neck pressure cases

  • Brain removal first to facilitate draining blood from the cranium

  • Thoraco-abdominal organs may also be removed for blood drainage

  • Uses a V-cut skin incision, with careful layer-by-layer dissection

  • The primary goal is to avoid false signs of bleeding in soft tissues, particularly in the posterior pharyngeal wall

Special Pelvic Dissection

• Incision technique allows routine anterior body incision extended to cover the pubic area

• Pubic bones are sawed ~5 cm on either side of the pubic symphysis, with careful separation of tissues for pelvic content removal

• Tissue is fixed in formalin for sagittal plane assessment of structures like the vagina and rectum

• Cautions against disfiguring pelvic exenteration and consideration of less invasive techniques when possible

Supportive Services for Autopsy

• Involves various forensic specialties:

  • Forensic Odontology

  • Forensic Histopathology

  • Forensic Toxicology

  • Forensic Anthropology

  • Forensic Radiology

  • Forensic Photography

  • Forensic Serology

  • General Forensic Sciences

Conclusion

• Expression of gratitude from Dr. Ajith Tennakoon

• Open floor for questions regarding the presented material.