WHICH TECHNIQUE IS BEST FOR POST-MORTEM

EXAMINATION OF INTERNAL ORGANS?

DR. S.K. NAIK Assistant Professor

Department of Forensic Medicine,

Lady Hardinge Medical College

& Smt. S K Hospital, New Delhi-110001 (India)

Introduction:

Examination of the internal organs of dead body to detect any injury or pathology is an integral part of medico-legal post-mortem examination. After opening the body cavities, for examination of internal organs, different techniques have been advised by R. Virchow, C. Rokitansky, A. Ghon, M. Lettulae, etc.

Introduction…

India being a huge country having large numbers of forensic experts, mortuaries and mortuary attendants, all these techniques are used by different forensic experts at different places of India, depending upon the nature of the case, preference of the forensic expert, working experience of morgue attendants, available facilities at the mortuary, thus lacking uniformity throughout the country. The present authors have discussed the advantages and disadvantages of such techniques.

Principles of Autopsy

The postmortem examination must be systematic

It must be as complete as per the custom or law

It must achieve the goals of the autopsyProper technique of examination is

mandatory.With a rigid or flexible system, technique

comes to be an individual matter, compounded of experience, judgment, and manual skill.

Principles of Autopsy….

Individual techniques may differ in detail even though their underlying principles and purposes are identical.

The procedures must be sufficiently flexible to adapt to the demands of the individual case, and the prosector should prepare for the unusual case by acquiring dexterity in alternate techniques.

Evisceration Techniques

A number of general and specific autopsy techniques have been described, but the four major autopsy techniques differ chiefly in the methods used in removal of the organs and the order in which they are opened to the autopsy are generally only minor.

R.Virchow Technique

In the Virchow technique, the organs are removed one by one and dissected as removed.

This approach is good for demonstrating pathological change in individual organs, especially in high-risk autopsies or where permission is limited to one organ. This organ can be immediately removed and examined.

C.Rokitansky (in-situ) Technique This procedure is characterized by in situ

dissection, in part combined with en bloc removal. The term “Rokitansky technique” is used erroneously by many pathologists to designate the en masse technique.

Rokitansky is said “to have supervised 70,000 autopsies, and personally performed over 30,000, averaging two a day, seven days a week, for 45 years”.

C.Rokitansky (in-situ) Technique Basic principle: Disturb the connections

between organs as little as possible. Dissection occurs in situ with little

actualevisceration.

If abnormality is found, regions removedintact >combination of en bloc and in situ

M. Letulle (En Masse) Technique Thoracic, cervical, abdominal, and

pelvic organs are removed en masse and subsequently dissected into organ blocks. This is the best technique for preserving the vascular supply and relationships between organs.

Organs are removed as a single bulky aggregate.

A.Ghon (En Bloc) Technique

Maintain all connections between physiologically related organs: thoracic pluck, coeliac pluck, urogenital pluck

Various modifications of the en bloc technique are widely used. Thoracic and cervical organs, abdominal organs, and the uro-genital system are removed in functionally related blocks. This procedure is a compromise between the Virchow anden masse techniques, preserving anatomical relationships sufficiently for most cases while being simpler for one person to execute.

Advantages of Virchow Technique

1.All organs examined systematically>Brain > spinal cord >abdominal cavity>thoracic cavity organs individually removed and sectioned outside the body.

2.Have a systematic approach and simplicity for beginning prosectors

Disadvantages of Virchow Technique

1. Destruction of anatomic relationships.

2. Relationships between various organs may be hard to interpret.

Advantages of Rokitansky Technique

1. Practical for single examiner2. Capability of preserving abnormal

anatomic relationships3. No artifactual injury is introduced

during autopsy4. 2nd or 3rd autopsy can be performed

easily on the same dead body on subsequent period

5. Do not hurt the religious sentiments badly

Disadvantages of Rokitansky Technique 1. Expertise necessary to recognize

abnormalities2. Examination of all parts of all the internal

organs may not be possible, due to their attachments with other structures

3. Some injuries or pathology may be missed4. Once the cause of death is found, then

least attention is paid to other injury and pathology

5. Complete autopsy may not be performed on some occasions.

Advantages of M. Letulle Technique 1. Body can be made available to the undertaker quickly, without having to rush the dissection and risk obscuring findings or destroying important specimens.

2. It can be performed speedily3. Organs removed and stored for later

dissection4. Complete preservation of relationships

among organs

Advantages of M. Letulle Technique

1. All the organs are examined thoroughly

2. Not so difficult to practice3. Histopathology of all the organs can

be performed easily4. Embalming on the eviscerated body

will preserved the dead body for longer period.

Disadvantages of M. Letulle Technique The major disadvantage is that the

organ mass is often awkward to handle, andthe autopsy is difficult to perform without anassistant.

Gives false satisfaction of performing complete autopsy

No consent is taken for retention of organs for subsequent examination

Disadvantages of M. Letulle Technique Rarely performed by the autopsy

surgeon, morgue attendants are not properly trained and they are always hurry to finish their jobs. thus artifactual post-mortem injury induced to the organs are very hard to differentiate from ante-mortem injury

Organs dissected out of the body cavities are very rarely placed back at their respective sites; hence, it is difficult to perform 2nd or 3rd autopsy on such dead body

Disadvantages of M. Letulle Technique If organs are retained by 1st autopsy

surgeon, then subsequent autopsy on such eviscerated body will be totally futile exercise.

Retention of organs will cause congestion and will give bad odor to the morgue complex

Rate of negative or obscure autopsy is not less than in-situ examination

During evisceration, chance of dislodging of foreign bodies including firearm projectiles is very high

Advantages of A.Ghon Technique Preserve important anatomic

relations without unwieldy mass of organs

All the systems are examined one by one with their structural integrity

Pathological lesions and their extension can be observed well

Very helpful in case of sudden death

Disadvantages of A.Ghon Technique

Multiple organ system involvement complicates the procedure

Skill necessary to remove each block from the body intact; Morgue attendants cannot perform such procedure due to lack of anatomical knowledge and skill.

Requires much time; relatives of the deceased may become impatience.

Conclsion:

Considering the advantages and disadvantages of all the above techniques for evisceration, in-situ examination of all the internal organs (C. Rokitansky technique) must be carried out before proceeding for en-masse dissection or en-bloc dissection.

Thank You !