Same warning applies as before- if you’re not a fan of the slightly gory then please don’t continue. If you are, here goes the second part of my account of what we do at evisceration! If you haven’t already seen part I it’s here.
Once the cardiovascular block is removed, it usually becomes quite bloody due to having cut through the aorta at the point it passes the diaphragm. It’s true that after a stage called maximum lividity is reached (aka livor mortis around 12 hours maximum after death), the blood has sunk with gravity to the lowest sections of the body. A lot of this can reside in the major vessels and especially the aorta. I find that large amounts of blood can make it more difficult for me to eviscerate, and is sometimes why I’m a bigger fan of removing everything in one go. When I say this, I mean that once the small and large bowel are removed you can remove everything from tongue to bladder in one. Often not the best option as the whole lot can be incredibly heavy (or big), meaning difficulty in not only moving them because the bowls we use are not huge, but also in lifting them in the first place! Also, I’ve been told that being able to eviscerate in blocks is showing a great deal more skill rather than taking everything out together although I’m aware this could be a matter of opinion.
The next block, and the focus for this post, is the gastric block. The gastric block is the stomach, liver, spleen and pancreas. From what’s left after the cardiovascular block is removed, it’s everything at the front of the abdomen, I normally demonstrate this in a talk I give about eviscerating by placing one hand on my lower ribs and the other just above where my bladder is. Followed by showing its everything at the front by standing sideways. I’m sometimes told that demonstrating things on myself is not entirely pleasant, but it seems quite natural to me!
I start removing this block by raising the fatty layer that the bowel was removed from and begin tracing up behind it. What’s there of the mesentery (fatty tissue that the bowel connects to) and the peritoneum (lining of the abdomen) can be removed behind and upwards towards the rib cage. I tend to know that I’m doing the right thing because you will cut through two vessels in this area, which I believe are the coeliac artery and the inferior mesenteric artery (I say believe because I just tried to google to check and I couldn’t figure it out!). They sit close and I can normally count 1-2 and I know I’ve dissected the correct place.
(Edit: I wrote this last night and this morning had a case where I was able to practice and I actually completely changed my method thanks to some training. I wanted to leave it in to show that progression is still happening and I’m learning! My manager showed me how to start with the spleen side and then the other side from the liver and then up from the mesentery fatty tissue.)
One aspect that is obvious is the condition of the liver, you can usually tell by colour and size if something isn’t perfectly healthy. People will sometimes have absolutely massive livers weighing a few kilos, they will often be much paler than the healthy purple colour too. Not always, but this too can be linked to a sizeable spleen. The spleen is interesting too because it can be soft or firm. Soft spleens are difficult because they can be very friable and not easy to remove.
I’ll leave it there for this part, so there will definitely be a part III and keep an eye out for it. I’ll be writing a post for the weekend about my very busy week, keep an eye out for that too! In the meantime, if you have any questions about the above please get in touch via the comments or contact page. Also, if you notice any errors in my naming or definitions above get in touch, I don’t want to get anything wrong!