I am a rookie forensic pathologist blooging my way through the first year on the cutting room floor. It's graphic in here-- there's blood and worse. Look away or read on: it's up to you.

Tuesday, July 18, 2006

Autopsies for beginners, continued

So the trick to the liver is to stand on the decedent's left side (for righties) and pull it towards you. The right adrenal and kidney will present themselves for your evaluation as you're freeing up the posterior aspect, so be ready for these enthusiastic volunteers.

Also a good idea is to get the intestines out of your way. By now, they've become a nuisance. Just dig around behind the stomach for the ligament of Trietz and, once you've got it, transect the intestine right there and start delivering the intestines from the wound using the "sweet spot" of a pair of scissors directed right at the mesenteric border. (That'll make it easier to run the bowel later.) Pause at the cecum to identify and stock the appendix (people are very, very particular about appendices, as they have heard of them.) Then finish up your colectomy, digging deep at the rectum for your second transection. Now you've got a nice visualization to help you with the spleen, left kidney, and left adrenal.

If you've got a male (which I almost always do-- males die under suspicious circumstances with alarming frequency: be careful out there, guys!) go ahead and dig out a hernia on each side then reach into the scrotal sac and deliver the testes one by one. Be very careful that you've really got a testis and not the corpora of the penis, as transection of the latter results in a nasty shock for the embalmers and a long, awkward conversation for your boss and the family. No, they will definitely not understand that this is an easy mistake to make so just don't make it. If you're not 100% sure you're doing it right, go find someone who is.

The neck dissection is tricky and best left to the professionals (meaning your assistant) as the main danger here is that you will mistakenly transect the skin as you round the curve at the base of the tongue, resulting in a "buttonhole" which results in more work for the morticians. (Plus they'll snap you with wet towels in the locker room.)