Postmortem Changes

Dr. Sulaiman Nimer

Postmortem changes after death
• Rapid (Immediate) Changes

• Early Changes

• Late Changes
Postmortem changes after death
• Rapid (Immediate) Changes

• Early Changes

• Late Changes
 Rapid (Immediate) Changes
• Initially, these changes can only be detected
biochemically as the metabolism in the cells alters to
autolytic pathways.
• These visible changes are important for two reasons:
1) because a doctor needs to know the normal progress of
decomposition so that he does not misinterpret these
normal changes for signs of an unnatural death .

2) because they may be used in estimating how long the

individual has been dead .
Rapid (Immediate) Changes
• The cells that can use anoxic pathways until their
metabolic reserves are exhausted, and then their
metabolism will begin to fail.
• neuronal activity ..
- loss of neuronal activity
- all nervous activity ceases
- the reflexes are lost and breathing stops.

• In the eye
-the corneal reflex ceases
-pupils stop reacting to light
-The eyes themselves lose their intraocular tension.
• The muscles..
- rapidly become flaccid (primary flaccidity), with complete
loss of tone, but they may retain their reactivity and may
respond to touch or taps and other forms of stimulation for
some hours after cardiac arrest. Discharges of the dying
motor neurons may stimulate small groups of muscle cells
and lead to focal twitching, although these decrease with
time.
- Loss of muscle tone may result in voiding of urine.
• Skin..
- skin, conjunctivae and mucous membranes pale. The skin
of the face and the lips may remain red or blue in color in
hypoxic/congestive deaths.
- The hair follicles die at the same time as the rest of the
skin .

• There is no truth in the belief that hair continues to grow

after death, although the beard may appear more
prominent against a pale skin.
• Regurgitation of gastric contents is a very common
feature of terminal collapse and it is a common
complication of resuscitation. Gastric contents are
identified in the mouth or airways in a significant
proportion of all autopsies.
Postmortem changes after death
• Rapid (Immediate) Changes

• Early Changes ( from ½ hour – 24 hours)

• Late Changes
Cooling of the body after death
• the body is not a uniform structure, its temperature will
not fall evenly and, because each body will lie in its own
unique environment, each body will cool at a different
speed, depending upon the many factors surrounding it .

• The first 2 hours .. The T will be same

• After 2 hours of death .. The body starts to loose its T and
cooling starts.
 • Examples of factors affecting the rate of cooling of a body
● Mass of the body
● Mass/surface area
● Body temperature at the time of death
● Site of reading of body temperature(s)
● Posture of the body – extended or curled into a fetal position
● Clothing – type of material, position on the body – or lack of it
● Obesity – fat is a good insulator
● Emaciation – lack of muscle bulk allows a body to cool faster
● Environmental temperature
● Winds, rain, humidity
 Rigor mortis
• is a temperature dependent physicochemical change that
occurs within muscle cells as a result of lack of oxygen.

• In the face of low ATP and high acidity, the actin and
myosin fibers bind together and form a gel.

• The outward result of these complex cellular metabolic

changes is that the muscles become stiff. However, they
do not shorten unless they are under tension.
• It is clear from the short discussion above that if muscle
glycogen levels are low, or if the muscle cells are acidic at
the time of death as a result of exercise the process of
rigor will develop faster.

• Electrocution is also associated with rapidly developing

rigor and this may be caused by the repeated stimulation
of the muscles.
• Rigor develops uniformly throughout the body but it is
generally first detectable in the smaller muscle groups
such as those around the eyes and mouth, the jaw and the
fingers.

• It appears to advance down the body from the head to

the legs as larger and larger muscle groups become
stiffened.

• as rigor is such a variable process that it can never

provide an accurate assessment of the time of death.
Extreme caution should be exercised in trying to assign a
time of death based on the very subjective assessment of
the degree and extent of rigor.
 Rigor mortis
1) affected by temperature: the colder the temperature
the slower the reactions and vice versa.

2) the microenvironment around the body when assessing

rigor: a body lying in front of a fire or in a bath of hot water
will develop rigor more rapidly than if it were lying outside
in winter.
Time !
• In temperate conditions rigor can commonly be
detected in the face between approximately 1 hour
and 4 hours
• the limbs, between approximately 3 hours and 6
hours after death.
• the strength of rigor increasing to a maximum by
approximately 18 hours after death.
• Once established, rigor will remain for up to
approximately 50 hours after death until autolysis and
decomposition of muscle cells intervenes and muscles
become flaccid again.
• These times are only guidelines and can never be
absolute
 Test for rigor mortis
• It is best to test for rigor across a joint using very gentle
pressure from one or two fingers only;

-- the aim is to detect the presence and extent of the

stiffness, not to ‘break’ it.
Cadaveric rigidity
the stiffness of muscles that has its onset immediately at
death, the finding of items gripped firmly in the hand
before the onset of normal rigor.

• Because of high levels of emotional or physical stress

immediately before death and many reports relate to
battlefield casualties.

• The mechanism for this phenomenon is possibly

neurogenic, but no scientifically satisfactory explanation
has been given. It is clearly not the same chemical
process as true rigor.
Cadaveric rigidity – a rare post-mortem finding
that may be seen in bodies recovered from water,
where vegetation is found tightly ‘gripped’ in the
hand.
Post-mortem hypostasis / Livor mortis

• Stasis of blood at the dependent areas is called “Post-

mortem hypostasis or post-mortem lividity” .

• Post-mortem hypostasis occurs where superficial blood

vessels can be distended by blood. This results in a pink
or bluish color to these areas.

• Relative pallor within hypostasis may also be caused by

pressure of clothing or by contact of one area of the
body with another
 • Hypostasis is not always seen in a body and it may be
absent in :
- the young
- old
- clinically anaemic or in those who have died from severe
blood loss.

- It may be masked by dark skin colors, by jaundice or by

some dermatological conditions.
• The site and distribution of the hypostasis must
be considered in the position of the body after
death.
Post-mortem hypostasis in a posterior distribution.
Areas of pallor can be seen as a result of pressure of the body
on a firm surface, whereas parts of the body not in direct contact
with that surface are purple/ pink because of the ‘settling of
blood under gravity’. This body has been lying on its back since
death.
• Post-mortem hypostasis pattern on the
front of a body found face down on a bed.
The linear marks are formed by pressure
from creases in a blanket. Pallor around
the mouth and nose are caused by
pressure against the bed and do not
necessarily indicate marks of suffocation.
*In general, no attempt should be made to form any
conclusions about the cause of death from these variations
of color.

*a few color changes that may act as indicators of possible

causes of death:
-the cherry pink color of carbon monoxide poisoning
-the dark red or brick red color associated with cyanide
poisoning
-infection by Clostridium perfringens, which is said to result
in bronze hypostasis.
in some congestive hypoxic states, blue.
Postmortem changes after death
• Rapid (Immediate) Changes

• Early Changes

• Late Changes
Decomposition/putrefaction
• In the cycle of life, dead bodies are usually returned,
through reduction into their various components.

• 1) Some components will do this by entering the food

chain at almost any level – from ant to tiger –
• 2) whereas others will be reduced to simple chemicals by
autolytic enzymatic processes built into the lysosomes of
each cell.
• important? because these changes may be confused by
the police with the signs of violence or trauma.
• Decomposition depends on the ambient temperature &
microenviroment surrounding: the warmer the
temperature, the earlier the process starts and the faster it
progresses.
• In the air surface much rapid than water than soil

• In temperate climates the process is usually first visible to

the naked eye at about 3–4 days as an area of green
discoloration of the right iliac fossa of the anterior
abdominal wall. This ‘greening’ is the result of the
extension of the commensal gut bacteria through the
bowel wall and into the skin, where they decompose
haemoglobin, resulting in the green color.
Why the right iliac fossa ?
• The right iliac fossa is the usual origin as the caecum lies
close to the abdominal wall at this site. This green color
is an external marker of the profound changes that are
occurring in the body as the gut bacteria find their way
out of the bowel lumen into the abdominal cavity and
the blood vessels.
Post-mortem hypostasis distribution following
hanging. Note the skin discoloration is in the legs and hands
because of the vertical body position after death and the
green discoloration in the right iliac fossa region.
• decomposition of haemoglobin when present in the
superficial vessels, results in linear branching patterns of
variable discoloration of the skin that is called ‘marbling’.

• Over time, generalized skin discoloration occurs and, as

the superficial layers of the skin lose cohesion, blisters
containing red or brown fluid form in many areas. When
the blisters burst, the skin sloughs off.
Early decomposition with skin slippage and discoloration. Note the
‘marbling’ representing discoloration owing to decomposition
within superficial blood vessels.
* Considerable gas formation in soft tissues and body
cavities is common

* the body begins to swell, with bloating of the face,

abdomen, breasts and genitals

* blood-stained fluid up from the lungs often ‘leaks out’ of

the mouth and nose as ‘purge fluid’.
Putrefaction/decomposition of approximately 1 week in
temperate summer conditions.
Note the ‘bloating’ of soft tissues, distortion of facial features
and ‘purge fluid’ emanating from the mouth and nose.
• the prostate and the uterus are relatively resistant to
putrefaction and they may survive for months, as may the
tendons and ligaments.

• Eventually, skeletalization will be complete and unless the

bones are destroyed by larger animals, they may remain for
years.
• No reliable ‘timetable’ for decomposition can be constructed
because environmental factors may favor enhanced or
delayed decomposition, and such factors will generally be
unknown to those investigating the death.
Immersion and burial

• Immersion in water or burial will slow the process of

decomposition.
Disposition of a body floating in water. Typically the head
and limbs hang down, resulting in superficial injuries to
the head/ face, back of the arms and hands, knees and
top of the feet.
The changes affect the body in
water :
• the loss of epidermis.
• Gaseous decomposition progresses and the bloated body
is often, but not always, lifted to the surface by these
gases, most commonly at about 1 week but this time is
extremely variable.
• Marine predators can cause extensive damage .
• Exposure to water can, in some cases, predispose to the
formation of adipocere ,but this is unusual unless a body
lies underwater for many weeks.
Adipocere
• Adipocere is a chemical change in the body fat, which is
hydrolysed to a waxy compound.

• The need for water means that this process is most

commonly seen in bodies found in wet conditions (i.e.
submerged in water or buried in wet ground)
• In the early stages of formation, adipocere is a pale,
greasy semi-fluid material with a most unpleasant smell.
As the hydrolysis progresses, the material becomes more
brittle and whiter and, when fully formed, adipocere is a
grey, firm, waxy compound that maintains the shape of
the body.

• The speed with which adipocere usually take weeks or

months, but it is reported to have occurred in as little as
3 weeks. All three stages of adipocere formation can
coexist and they can also be found with areas of
mummification and putrefaction if the conditions are
correct.
Mummification
• A body lying in dry conditions, may desiccate instead of
putrefy – a process known as mummification.

• Mummified tissue is dry and leathery and often brown in

color.

• It is most commonly seen in warm or hot environments

such as desert and led to the spontaneous
mummification of bodies buried in the sand in Egypt.
• much more likely in thin individual whose body will cool
and desiccate quickly.

• Mummification need not affect the whole body, and

some parts may show the normal soft tissue
decomposition changes, skeletalization or formation of
adipocere, depending on the conditions.
Mummification. The skin is dry and leathery following recovery
from a locked room for 10 weeks.
• Mummified tissues are not immune to degradation and
invasion by rodents, beetles and moths, especially the
brown house moth, in temperate climates
Skeletalization
• The speed of skeletalization will depend on many factors:
- climate and the microenvironment around the body. It
will occur much more quickly in a body on the surface of
the ground than in one that is buried.

- in a formally buried body, the soft tissues will be absent

by 2 years. Tendons, ligaments, hair and nails will be
identifiable for some time after that.
- At about 5 years, the bones will be disarticulated,
although fragments of articular cartilage may be
identified for many years and for
• several years the bones will feel slightly greasy and, if
they are cut with a saw, a wisp of smoke and a smell of
burning organic material may be present.
• Examination of the bone marrow space may reveal
residual organic material that can sometimes be suitable
for specialist DNA analysis.

• Examination of the cut surface of a long bone under UV

light may assist in dating, as there are changes in the
pattern of fluorescence over time.
Post-mortem injuries
• Dead bodies are not immune to injuries and can be exposed to a
wide range of trauma, and it is important to bear this possibility in
mind when examining any body so that these injuries are not
confused with injuries sustained during life.

• It is not true to say that post-mortem injuries do not bleed

because many do leak blood, especially those on the scalp and in
bodies recovered from water.

• In general, post-mortem injuries do not have a rim of an early

inflammatory response in the wound edges, but the lack of this
response does not exclude an injury inflicted in the last moments
of life.
Post-mortem animal predation. The wound margins of
these rat bites are free from hemorrhage or reddening.
Such injuries are commonly present around the eyes, ears
and nose.
Estimation of the post-mortem interval
• The pathologist is often asked for an opinion on PMI (the
‘time since death’) based on the pathological findings.

• While none of the changes after death is capable of

providing a precise ‘marker’ of PMI, the most reliable
would appear to be related to the cooling of the body
after death.
Body temperature
• Traditionally, the temperature of the body was taken
rectally using a long, low-reading thermometer(0–50°C
was considered to be adequate).

• Then, they developed a small electronic temperature

probes with rapid response times and digital
techniques used in estimating PMI
• Entomology… can be good by determine the type of
magot , from which generation

• Currently, the most useful method of estimating the time

of death is Henssge’s Nomogram.
-relies on three measurements :
1- body temperature
2- ambient temperature
3- body weight
lack of accuracy in any one of these will degrade the final
result.
techniques used in estimating PMI

• Many pathologists have in the past used various ‘rules of

thumb’ to calculate the time of death from the body
temperature but these are generally so unreliable that
they should not now be used.

• Biochemical methods, including vitreous humour

potassium levels and changes in enzyme and electrolyte
levels elsewhere in the body, have been researched;
some remain as interesting research tools but none has
been successful in routine work.
techniques used in estimating PMI
• Analysis of gastric contents –
may occasionally assist in an investigation, where such
analysis identifies food components capable of
corroborating other evidence,
*but cannot reliably be used to determine time of death.
Maggot infestation of a body recovered from
heated premises approximately 2 weeks after death. Forensic
entomology may assist in estimating post-mortem interval
(PMI).
THANK YOU