Medico-Legal Autopsy Revised

MEDICO-LEGAL AUTOPSY
• Prof. Dr. H.Wasti

Former Chief Consultant GoN
Vis. Professor IOM, PAHS, PU
INQUEST
Investigation or inquiry into the cause of death where death
has occurred in a suspicious circumstances.
Types:
1. Coroner’s inquest
2. Police inquest
3. Magistrate’s or court’s inquest
4. Medical examiner’s inquest
IN Nepal: police inquest is the most common one.

Autopsy (Post Mortem Examination)
Examination of a human body, body parts and skeletal
remains after death.
1. Pathological Autopsy
2. Medico-legal or forensic Autopsy
-Muluki Criminal Procedural Code 2074
-Police Act 2012
Types of death for M-L Autopsy
a. Non-criminal deaths:
-Accidents
-Suicides
-Death from sudden natural causes
-Industrial Deaths
-Death in custody
(Brought dead at hospital cases) !
b. Criminal Deaths:
-Suspicious
-Frankly Criminal.
New Legal Provisions
1. Muluki Criminal Procedure (Code) 2074
Sec 20 Autopsy to be performed:
Any person if dies in suicidal, homicidal, accidental,
unusual or suspicious circumstance, the investigation
Officer must go to scene and investigate
Documentation as per format of annex 14
Body should be sent to Govt. hospital or the
authorized Specialist or Doctor
Doctor should prepare report as per annex 15 format
(Autopsy format); submit within 3 days
If body is decomposed, collect samples for further
investigation
If necessary, accompany the Expert to scene
investigation
If necessary, perform autopsy by team of experts
Cont..
Police Act (2012) Sec.22 (ka)

• In case of unidentified body, after investigation
disposal by police through VDC or municipality or
hand over to Medical Colleges for teaching
learning purpose.
Objectives of an Autopsy:
• To make positive identification of the body.
• To determine the cause of death.
• To determine the mode of dying and time of death,
where necessary and possible.
• To demonstrate all the external and internal
abnormalities, malformation and diseases.
• To detect, describe and measure any external and
internal injuries.
• To obtain samples for analysis; histological,
microbiological, toxicological and other necessary
investigations.
• To retain foreign bodies, organs or tissue as an
evidence.
• To know whether live birth or still birth
• To obtain photographs, video and films for
evidence.
• To provide full written report of the autopsy
findings and to make an expert opinion of those
findings.
• To restore the body to the best possible cosmetic
condition before release to the relatives.
Preliminaries to an Autopsy:
1.Authorization: (in Nepal Police office)

• Inquest letter
• Preliminary investigation report (body and scene
description -> Muchulka) (Ghatnasthal and lash janch
muchulka)
2. Authorized place- Govt.hospitals or Specialists authorized
by GoN
3. Preferably by Specialist or doctors trained in the field
4. Specialist should be taken to scene when necessary
5.No consent is needed by the relatives.
6.The body must be identified by relatives/police
attendant
7. Report should be prepared in annexed format
Autopsy Procedure: Ref. SOP for autopsy (MoHP)

1.Description of the body; general viewing
-clothing detail
-personal belongings.
2.External Examination
3.Internal Examination
Background information; relevant details of the case
(history or circumstances of death)
Cloth and personal belongings
External Examination:
• General description; how body looks like?
• Body length
• Body weight (estimated)
• Built complexion
• Scalp hair
• Beards, mustaches
• Tattoo, moles, scars and deformities
• Condition of the eye
• Position of the tongue
• Cyanosis, petecheal hemorrhages
• Staining, blood, mud, any other
• Natural orifices:
Mouth, noses, ears, urethra, vagina, anal orifice

-any discharge; amount, color, nature
Changes after death in dead body
• Postmortem staining
• Rigor mortis
• Cadaveric spasm, contents of the hand
• State of the decomposition
• Partial skeletanization
• Skeletanization
• Mummification
• Adipocere formation
External examination
• Injuries-
-nature, size, site,
-direction, color, age
-content, surrounds
-bleeding, signs of infection
-sign of repetition
-any imprint or pattern
• Any ligature mark on the neck

External examination
• Genitalia:
-observe any abnormality
-any stain
-any discharge
-any injury
-condition of pubic hairs
• To take swabs from stained parts

• Vaginal swabs collection, if indicated
Internal Examination:
All three cavities must be opened.
(Head, Chest and Abdomen)
• Cranial cavity: (Head)
-An incision in scalp start back of one ear continue to other
ear.
-Flap out of the skin anteriorly and posteriorly.
-Record any contusion and fracture of the skull bones.
-Sawing or chiseling out the skull vault above eyebrow in
front and at the level of occipital protuberance at the back.
-Examination of the brain with dura intact and removal of
dura.
-Falx cerebri and tentorium cerebelli are incised, cranial nerve
roots are cut, go down in foramen magnum as far as
possible and cut.
-Examination of brain and base of the skull.
Incision on scalp
Giving incision from one ear to other ear through top of head
Reflecting the scalp from the skull
Sawing the scalp
Separation of the skull vault
Opening of the cranial cavity
Cutting the dura matter
Retraction of the brain
Cutting of the brain stem and the cranial
nerves
Cutting the tentorium cerebelli to expose the
cerebellum
Brain is removed from the cranial cavity
Separation of the cerebellum
Cross sectioning of the brain stem
Cross sectioning of the cerebellum
Sectioning of the brain
Sectioning of the brain
Sectioned brain
Fracture of skull bone
Base of
skull
Thoracic (chest) and abdominal cavities:
• ‘I’ or ‘Y’ shaped incision chin to pubis
• Flap out the skin and muscles on either side.
• Ribs cut through cartilages with disarticulation of sterno-
clavicular joints.
• Sternum lifted up
• Examination of internal organs and other contents in situ.
• Eviscerate the organs en bloc (thoracic and abdominal
organs are taken out together)
• Systematically examine each organs
• Record all the findings
• Special neck dissection
• Special pelvic dissection
Giving incision from chin to pubis
Reflection of the skin, subcutaneous tissue
and chest muscles
Cutting the ribs at both side of the chest
Removal of the anterior chest wall
Anterior chest wall removed
Cutting along the lower border of lower jaw
to free the tongue
Tongue released
Taking out of the chest organs
Cutting the diaphragm muscle
Pulling out the abdominal viscera
Viscera taken out
Dissection of the aorta
Opening the oesophagus
Separating the lungs
Dissection of the lungs
Squeezing the lungs to see the nature of
expressed fluid
Removal of the heart from the Pericardial
sac
Separating the heart
Dissection of the Left anterior descending
coronary artery
Coronary arteries are dissected along their
distributions.
Serial sectioning of the Left anterior
descending coronary artery
Lumen of the coronary artery
Opening of the cavity of the heart according
to the flow of blood
Dissection of the heart for demonstration of
the myocardium
Special neck dissection
• When necessary?
-any case where there are injuries on neck,
externally
-in case of hanging,
-in case of ligature strangulation,
-in case of manual strangulation,
-other suspicious circumstances
• In some cases there may not be any outer
injuries but may present internal injuries
Neck dissection in hanging
and strangulation
Negative Autopsy:
In 5-10% cases in every center the cause of the death remains
unknown even after thorough autopsy and all other
investigation. This is more common in infants death and
death in young individuals.
In Nepal huge number of autopsies are negative
Causes:
Insufficient knowledge, skills,
Lack of autopsy facilities ,
Lack of competent lab. facilities,
Incomplete examination,
Ignorance in work
Incomplete background information or history
Collection and preservation of viscerae and other materials in
poisoning death or in suspected poisoning case.
A. Usual Samples: in case of ingestion

• Stomach with its content
• Liver 200gm piece
• Half of each kidneys
• Blood 10-15ml
Sample collection
B. In particular cases:
• Urine 100ml
• Bile
• Lungs: part of both-volatile poisons
• Bones: heavy metal, diatom
• Hairs, nails: arsenic, copper
• Uterus: abortifacient drugs
• Skin scrap, skin with subcutaneous tissue
C. Preservation:
1. Saturated solution of common salt (NaCl)
for toxicology.
2. 10% formalin: tissue samples for histolo-pathology

or biopsy
3. E.D.T.A and NaF: for blood preservation

Container for viscera preservation:
For viscera:
-glass or plastic made, wide mouth, sterile and with
tight lid (air tight container).
For Blood, urine, bile:
-glass tube/glass bottle.
D. Labeling
E. Seal
F. Chain of custody.

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MEDICO-LEGAL AUTOPSY

• Prof. Dr. H.Wasti

IN Nepal: police inquest is the most common one.

Police Act (2012) Sec.22 (ka)

1.Authorization: (in Nepal Police office)

Autopsy Procedure: Ref. SOP for autopsy (MoHP)

Mouth, noses, ears, urethra, vagina, anal orifice

• Any ligature mark on the neck

• To take swabs from stained parts

A. Usual Samples: in case of ingestion

2. 10% formalin: tissue samples for histolo-pathology

3. E.D.T.A and NaF: for blood preservation

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