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 autopsy
 Proper 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 actual
evisceration.
 If abnormality is found, regions removed
intact >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 and
en 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 examiner

2. Capability of preserving abnormal anatomic
relationships
3. No artifactual injury is introduced during autopsy
4. 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 abnormalities
2. 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 missed
4. 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
1. Technique
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 speedily
3. Organs removed and stored for later dissection
4. Complete preservation of relationships among
organs
 Advantages of M. Letulle
Technique
1. All the organs are examined thoroughly
2. Not so difficult to practice
3. Histopathology of all the organs can be performed
easily
4. 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, and
the autopsy is difficult to perform without an
assistant.
 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 1 autopsy surgeon,
st

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 !