Evisceration (Part I)

This week I have been fairly solidly revising alongside putting together a presentation for a very exciting project (should it come to fruition which I hope it does!). I wondered if some people would like me to share the contents on here, and I figured why not as long as I give a little warning to start that this post may not be for the highly squeamish or faint hearted. For those that the former warning does not apply to, here we go. I know I have covered these before, but it’s always worth going over again especially with anything new that I’ve learnt.

Evisceration.

It’s a word that I use a fair amount to describe the part of my job known as ‘technical support at autopsy’. The literal definition is ‘removal of viscera (internal organs, especially those in the abdominal cavity)’ according to Wikipedia, but we use it as a much more general term for removal of all the organs tongue to bladder and everything in-between. You may have noticed some people say post mortem, some say autopsy. I seem to prefer the word post mortem but do sometimes use autopsy and I think the latter is more common in general use. Technically speaking I should say post-mortem examination because post-mortem could refer to anything after death, whereas autopsy is exclusively for the process meaning ‘to see for oneself’ in Greek.

Initially we open the body using generally one of two incision styles. We can use the ‘I’ (or midline) incision which runs from around the centre of the clavicles to the pubis region of the pelvis. The line is straight apart from maybe a little wiggle around the umbilical or belly button to avoid it. The other incision we may use is the classic Y incision that you always see on television or in the movies. This tends to only be used if we need to examine the neck structures in the event of trauma, like strangulation, which is why it is rare.

Attempt to show the two incision styles, the straight line of the midline, the deviation at the clavicles for the Y incision and the ‘wiggle’ at the umbilical. Oh, and a cat paw.

The first step is to examine the bowel and then remove it from where it begins at the stomach all the way down to the anus. I’ve got better at following the bowel, noticing the appendix and recognising the different structures. Weirdly, the appendix could not look more different in people if it tried. Sometimes it’s long and thick-ish like an earthworm, other times short and stubby, sometimes so thin you can barely see it. I do like finding the appendix and noting what it’s like! The other organ I like to spot at this time is the spleen, tucked up under the diaphragm on the left hand side. I’m still waiting for the day when I have a patient with situs inversus, I’ll probably only notice once I see that the spleen isn’t on the left and have to go looking on the right!

Once the bowel is removed, the next block to be removed is the cardiothoracic block. The tongue down to the diaphragm, including the major features of the trachea, oesophagus, lungs, heart, and part of the aorta. The tongue can be difficult to remove and involves a lot of blind work. It has taken me a long time to get to a point where I don’t have to ask for help any more with this part! The tongue is normally the part that everyone looks horrified and asks why on earth you need to remove it. Fairly simply, examination of the tongue can tell a lot about a person including if there are any bite marks. Full removal of everything including the tongue also allows a successful plugging of the cavity during reconstruction, meaning it can be ensured that there will be no leaking of anything unpleasant.

 

I have tried to draw some illustrations to this but I’m a little rusty plus Ruby refuses to let me as she always tries to eat the pencil…

I think I will leave that there for Part I and go onto the next sections in Part II and possibly a Part III if I think I have enough to talk about. If you have any questions on the above let me know, you must have one or two! Get in touch via the contact page and I’ll respond plus add them into the next post.

MG x