An autopsy, or post-mortem examination, is a specialized surgical procedure performed after death to determine the cause and manner of death, evaluate disease, or study the effects of medical treatments. While clinical autopsies focus on understanding natural causes of death for medical purposes, forensic autopsies are conducted for legal reasons in cases of suspicious, unexpected, or unnatural death. The internal examination is always preceded by a meticulous external assessment, which includes documentation, photography, and the collection of surface evidence and toxicology samples. Once the external survey is complete, the focus shifts to systematically accessing the body’s internal cavities to begin the detailed inspection of the organs.
The Initial Incision for Internal Access
The first step of the internal autopsy is the creation of a large, deep incision to open the trunk and expose the underlying structures. The most common approach is the Y-incision, so named because it begins high on the shoulders and runs down the chest to meet at the breastbone, continuing in a single straight line down to the pubic bone. For female bodies, the incision is often curved around the breasts before meeting centrally, and this method provides maximum exposure to the chest and abdomen. A less common alternative is the straight I-shaped incision, which runs vertically from the chin or sternal notch down to the pubic area, or the T-incision, which involves a horizontal cut across the chest.
After the skin and underlying soft tissues are cut with a scalpel, the pathologist or assistant will retract these large flaps to expose the ribcage and abdominal muscle wall. Specialized tools are required to access the thoracic cavity. Rib shears are used to cut through the costal cartilages and ribs on both sides. A sternal saw, often a vibrating electric saw, may be used to detach the sternum (breastbone). Once the entire ribcage shield, known as the sternal plate, is removed, the major internal organs of the chest and abdomen become visible.
The Initial Internal Survey
Immediately after the chest and abdominal cavities are opened and the sternal plate is removed, the pathologist performs a quick, non-invasive assessment known as the in situ examination. This involves visually inspecting the organs while they are still in their natural anatomical position. The pathologist looks for any signs of pathology, such as unusual organ color, size, or position, and notes the presence of fluids in the cavities, such as blood, edema, or pus. This initial survey is important because removing organs can disrupt their relationships and cause fluid to drain, making it difficult to assess the original state of the body.
The pathologist may also perform palpation, gently touching the organs to assess their consistency, density, and size before any manipulation occurs. If a collapsed lung is suspected, a test to check for tension pneumothorax can be performed by making a small incision under a pool of water to observe for escaping air bubbles. Additionally, initial fluid samples for microbiology or toxicology may be collected at this stage to ensure the specimens are taken before the organs are moved or dissected. This observational phase ensures that evidence relating to the cause of death is not accidentally obscured before the systematic removal of organs begins.
Systematic Organ Removal
The final step in the internal examination is evisceration, which is the systematic removal of the internal organs for detailed study. Pathologists employ various techniques to maintain anatomical context and ensure a thorough examination. One common method is the Ghon technique, or en bloc method, where the organs are removed in three or four functionally related blocks, such as the thoracic block (heart and lungs) and the abdominal block (liver, stomach, intestines). Alternatively, the Letulle method, or en masse technique, involves removing all the neck, chest, abdominal, and pelvic organs as one continuous, large mass.
The choice of technique often depends on the specific circumstances of the case, but the goal is to preserve the relationships between organs, which can be important for trauma cases. Once removed from the body, each organ is weighed, measured, and meticulously dissected to observe its internal structure, a process sometimes called “bread-loafing” due to the slicing pattern. Small tissue samples are then selected and preserved for further microscopic examination, or histology, and other samples are collected for specialized toxicology testing. This detailed analysis of the removed organ masses allows the pathologist to identify subtle signs of disease or injury that were not apparent during the initial survey.