Chapter 1408 Systemic Anatomy Following External Examination
Chapter 1408 Systemic Anatomy Following External Examination
After the external examination of the body, Zhang Lin began the systematic autopsy. "First, we performed a thoracic and abdominal dissection, using a straight incision, starting from the midline of the lower jaw, passing through the midline of the sternum to above the pubic symphysis, avoiding the navel." Holding a scalpel at a 30-degree angle to the skin, Zhang Lin made a precise incision, smoothly cutting through the skin. The subcutaneous fat tissue was pale yellow and about 2.5 centimeters thick. "The thickness of the subcutaneous fat is normal, with no abnormal proliferation or signs of emaciation, indicating that the deceased was in good nutritional condition."
After incising the subcutaneous tissue to expose the chest and abdominal muscles, Zhang Lin used hemostatic forceps to separate the muscle tissue, avoiding damage to blood vessels and internal organs: "Separate the pectoralis major and rectus abdominis muscles to expose the sternum and ribs. Xiao Lin, prepare the rib shears. Starting from the second intercostal space, cut the ribs on both sides to open the chest cavity." The rib shears snapped against the ribs, making a slight "click" sound. The ribs on both sides were cut one by one. Zhang Lin carefully removed the sternum, and the internal structures of the chest cavity were completely exposed: "The lung tissue on both sides is light red, with a smooth surface, and no signs of nodules, adhesions, or ruptures; the heart is located in the center of the chest cavity, is of normal size, and there are no bleeding points on the epicardium."
He lifted the pericardium with tweezers and cut it open with a scalpel, revealing the internal structure of the heart: "The left ventricular wall is about 1.2 cm thick, and the right ventricular wall is about 0.3 cm thick, consistent with the structure of a normal adult heart; there are no signs of stenosis, hardening, or embolism in the coronary arteries; there are no blood clots in the atria and ventricles, only a small amount of dark red blood residue." Zhang Lin extracted a small amount of heart tissue and placed it in a sampling box labeled "Heart Tissue Sample": "Subsequent pathological section examination will rule out sudden death caused by heart disease."
Then, Zhang Lin turned to the abdominal cavity: "Open the abdominal cavity and expose the internal organs. The liver is located in the upper right abdomen, reddish-brown in color, smooth in surface, soft in texture, without swelling, nodules or rupture; the spleen is located in the upper left abdomen, about 12x7x4 cm in size, dark red in color, medium in texture, without bleeding or infarction; the stomach is located in the upper left abdomen, moderately full, with no damage, ulcers or perforations in the stomach wall." He used hemostatic forceps to clamp the cardia and pylorus of the stomach, cut the connection between the stomach wall and the surrounding tissues, and removed the stomach intact, placing it on an electronic scale to weigh it: "The stomach weighs about 350 grams, and contains about 150 grams of stomach contents."
“Now we’ll examine the stomach contents, which is an important supplementary basis for estimating the time of death.” Zhang Lin used a scalpel to cut open the stomach wall. The stomach contents were semi-liquid, mainly consisting of rice, vegetables, and meat residue, with no obvious undigested food particles. “The stomach contents were in the middle stage of digestion. The rice and vegetables were basically digested into a semi-liquid, while the meat residue still had a few lumps.” Zhang Lin used a cotton swab to extract some stomach contents and placed them in a test tube labeled “Stomach Contents Sample.” “The gastric emptying time for adults is about 4-6 hours, and for mixed food, it takes 6-8 hours from ingestion to gastric emptying. The deceased’s stomach contents were in the middle stage of digestion, indicating that death occurred about 3-5 hours after eating. Combined with our previous estimate of the time of death being around 1 a.m., the deceased’s last meal should have been between 8 and 10 p.m. last night. This time also matches most people’s dinner time, further confirming the estimated time of death.”
Xiao Lin noted, "Teacher Zhang, so in that case, the time of death can be precisely pinpointed to within an hour before or after 1 a.m., which is between midnight last night and 2 a.m. this morning, right?" Zhang Lin nodded, "Yes, by cross-referencing five methods—body temperature, corneal opacity, rigor mortis, livor mortis, and the degree of digestion of stomach contents—this time range is highly reliable. Next, we will focus on investigating the cause of death, which is the core of the autopsy."
Zhang Lin refocused on the thoracic and abdominal cavities, carefully examining each organ for damage or abnormalities: "The cut surfaces of both lungs were pale red, and no foamy fluid was expelled upon squeezing, ruling out drowning; the liver, spleen, kidneys, and other solid organs showed no rupture or bleeding, ruling out internal bleeding caused by blunt force trauma; the gastrointestinal tract showed no perforation or bleeding, ruling out poisoning or digestive tract disease." He then examined the neck tissue, using a scalpel to cut open the neck skin and separate the subcutaneous tissue and muscles: "The neck muscles showed no bleeding or contusions; the thyroid gland was of normal size and showed no abnormal lesions; the hyoid bone and thyroid cartilage showed no fractures, ruling out mechanical asphyxiation caused by strangulation or ligation."
"Could it be death by poisoning?" Xiao Lin asked doubtfully. Zhang Lin nodded: "That possibility cannot be ruled out. Some poisonings do not leave obvious traces on the body surface or organ damage, and can only be confirmed through toxicology testing. We will collect tissue samples such as blood, urine, liver, and kidneys, and send them to the toxicology laboratory for comprehensive testing, including common organophosphorus pesticides, sleeping pills, rat poison, heavy metals, etc." He used a syringe to draw 10 ml of blood from the deceased's femoral artery and put it into an anticoagulant test tank; then he extracted a small amount of liver and kidney tissue, put them into sampling boxes, clearly labeled them, and sent them to the toxicology laboratory.
"Next, we will perform a craniocerebral autopsy to rule out death caused by craniocerebral injury." Zhang Lin took out a skull saw and made a horseshoe-shaped incision on the top of the deceased's head, sawing open the skull: "The skull bone is intact, without fractures, depressions, or cracks; the dura mater is intact, without rupture or bleeding; there is no blood accumulation in the subdural space or subarachnoid space, ruling out death caused by subdural hematoma or subarachnoid hemorrhage." He carefully removed the skull flap, exposing the brain tissue: "The brain tissue is light red, with a smooth surface, without signs of swelling, contusion, or necrosis; the cerebrum, cerebellum, and brainstem structures are intact, without any abnormal lesions." Zhang Lin extracted a small amount of brain tissue sample and placed it in a sampling box, preparing for pathological examination.
“Teacher Zhang, no obvious damage or lesions were found in any of the organs, so what was the cause of death?” Xiao Lin asked, somewhat puzzled. Zhang Lin frowned slightly and re-examined the key areas of the body: “Check the neck and mouth/nose area carefully again, make sure you haven’t missed any details.” He gently pried open the deceased’s lips with tweezers to examine the oral mucosa: “The oral mucosa showed no signs of damage, bleeding, or corrosion; the teeth were not loose or missing; the nasal mucosa was smooth, without any foreign objects or bleeding.” Then, he examined the neck tissue again, carefully observing the neck muscles and blood vessels with a magnifying glass: “Wait, there’s something abnormal here!”
Zhang Lin pointed to the deep muscles on the left side of the deceased's neck: "Look, there is a small amount of patchy bleeding in the middle of the sternocleidomastoid muscle, about 2x1 cm in area, and dark red in color. This is a characteristic of injury before death. In addition, there is a slight tear in the intima of the left carotid artery. Although it is not obvious, combined with the bleeding in the sternocleidomastoid muscle, it is speculated that the deceased may have suffered brief neck compression, resulting in insufficient blood supply to the carotid artery and causing death by asphyxiation."
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