Organ Autopsy Technique

1. The Four Classical Techniques for Organ Removal

Virchow's - cannot study anatomico-pathological relationships (organs separated). Letulle's - preserves relationships but the organ mass is awkward to handle. Rokitansky's - organs cannot be studied in as much detail.

• The Essentials of Forensic Medicine and Toxicology, 36th ed.; PC Dikshit Textbook of Forensic Medicine and Toxicology

2. Instruments

3. Primary Skin (External) Incisions

1. "I" (T)-shaped Incision: Straight vertical incision from chin to symphysis pubis, passing left or right of the umbilicus. The umbilicus is avoided as dense fibrous tissue there makes re-suturing difficult.
2. "Y"-shaped Incision: Begins near the acromial process on each side, extends below the breast to the xiphoid process, then continues straight down to symphysis pubis.
3. Modified "Y"-shaped Incision: Midline from suprasternal notch to symphysis pubis, with bilateral extensions from the suprasternal notch over the clavicle, then up and behind the ear. Best for examining neck organs.

Note: Incisions must be adapted to the case - e.g., stab wounds may require the standard incision line to be altered to avoid disturbing the wound track.

4. Opening the Body Cavities

Abdomen

• The pathologist stands on the right side of the body (if right-handed).
• Recti muscles divided ~5 cm above symphysis pubis.
• A small cut is made in the fascia, fingers inserted in a V-shape to protect underlying structures, then peritoneum cut upward to xiphoid.
• Before disturbing anything: note blood, pus, or fluid (measure quantity), perforation of organs, adhesions, fat in mesentery/omentum, and height of diaphragm.

Neck Dissection

• A block (12-20 cm) placed under shoulders to extend the neck.
• Dissection carried immediately deep to skin through platysma.
• In asphyxial deaths (hanging, strangulation): open the skull first and remove the brain to drain blood from the neck, enabling dissection in a relatively bloodless field and preventing artifactual haemorrhages.
• Sternomastoid muscle freed from clavicular and sternal attachments and reflected on each side.
• Omohyoid, sternothyroid, thyrohyoid muscles exposed and reflected.
• Thyroid gland and carotid sheaths freed by blunt dissection.
• Larynx, trachea, pharynx, and esophagus mobilized and pulled away from prevertebral tissue.

Mouth/Tongue Removal

• Knife inserted under the chin through the floor of the mouth.
• Cut along sides of mandible to its angle - at the angle, blade is turned inward to avoid the carotid artery.
• Tongue pushed down under the mandibular arch; soft palate cut to include uvula, tonsils, tongue, and neck organs.
• Dissection carried distally through prevertebral muscles on the anterior cervical spine surface.
• Great vessels (carotids) divided in the neck.

Pneumothorax Detection (before opening chest)

1. Dissect a pocket between chest wall and skin, fill with water, then puncture the wall under water - bubbling = pneumothorax.
2. 16-gauge needle attached to water-filled 50 mL syringe (without plunger) introduced into intercostal space - bubbling confirms air.
3. Remove intercostal muscle to expose parietal pleura - if pneumothorax is present, visceral pleura will not be visible immediately beneath it.
4. Chest X-ray.

Chest (Thoracic Cavity)

• Chest muscles dissected away, knife directed inward toward ribs, carried to midaxillary line.
• Ribs, sternum, and spine examined for fractures.
• Chest opened by cutting costal cartilage with a cartilage knife, beginning at the upper border of the 2nd cartilage, close to costochondral junctions, knife inclined ~30° to vertical.
• In elderly (calcified cartilages): rib shears or handsaw used.
• Sternoclavicular joints disarticulated by inserting knife vertically into the semicircular joint and rotating.
• Diaphragm divided at its rib and sternal attachments up to the spine.
• In situ inspection before full organ removal includes:
  • Lumen of main pulmonary vessels
  • Right atrium and ventricle for air embolism
  • State of lung distension or collapse
  • Pleural cavities for blood, fluid, or adhesions

5. General Principles of Evisceration and Documentation

• The pathologist should use the technique with which they are most comfortable.
• All organs must be weighed and a brief description recorded. "Unremarkable" is acceptable for pancreas, adrenals, and spleen with no positive findings. "Normal" should not be used.
• Samples from all major organs should be saved; microscopic slides made when indicated (often not needed in forensic trauma cases).
• Samples for toxicological analysis should be noted separately.
• Articles removed from the body (clothing, jewelry, bullets) must be labelled, documented in the report, and handed to police in a sealed cover.
• Pacemakers must be removed before cremation (mercury batteries explode when burnt).

6. Special Considerations

• In suspected cranial injury: do not open the skull until blood has been drained by opening the heart first, to avoid artefactual findings.
• For air embolism suspicion: neck dissection must be modified to avoid injuring large neck veins before examination.
• For infectious deaths: Rokitansky's technique is preferred to contain spread.