MEDICO-LEGAL ASPECTS OF

INVESTIGATION
PHYSICAL INJURIES
Blunt Force Wounds
Abrasions (Gasgas)
 Are scratches
and scrapes
involving outer
layers of skin,
including
grazes and
impact
impressions
Examination of abrasions can indicate:
 Exact site where object struck the
skin
 Direction the wounding object was
traveling when it struck the skin
Contusion / Bruise (Pasa’)
 A contusion is an injury that does
not break the skin, but results in
rupture of small blood vessels
causing skin discoloration
• Changes color as it ages (No
definite time-frame)
Hematoma (Bukol)
• Accumulation of blood in a newly-
formed cavity beneath the skin
• May be indicative of the amount of
force applied
Lacerations
 Are torn ragged wounds to skin or
internal organs
• Edges are Abraded edges
irregular
and abraded Torn skin
• Presence
of tissue /
nerve
bridges
Tissue Bridges
Sharp Force Injuries
Incised (Cutting) Wound
Wound characteristics
 Clean / Well defined edges
 Minimum bruising
 No bridging of nerves or vessels
 Length is greater than depth
Stab Wounds
Wound characteristics:
• Result of a pointed or sharp
object forced inward
• Depth is greater than length
 Presents danger to vital organs
May indicate the type of weapon
used by measuring:
Length

Width

Or presence of
Hilt mark
Punctured Wounds
Wound characteristics:
 Result of a pointed or sharp and usually
slender object forced inward
 Depth is greater than wound dimensions
 Presents danger to vital organs
Chopping / Hack Wounds
• These represent injuries caused by
relatively heavy sharp- edged
implements, such as machetes, meat
cleavers, swords, hatchets and axes,
etc…
• Wounds were inflicted by a swinging
action, usually in a vertical or oblique
plane from top to bottom – hence the
head being a favourite target of attack
Wound Characteristics
• Can have characteristics of both
incised and lacerated wounds
• Extensive
damage
Avulsion (skin
removal)
Eviscerations
(organ removal)
 Possible broken
Other Types of Injuries:
 Defensive Wounds - injuries that
occur to victim as they attempt to
defend themselves from an attack
 Wounds are usually found on
 Hands
 Fingers
 Arms
 Thighs / Legs
 Foot
They can be in forms of:
Cuts – fending off knife attack
Bruises – blocking blows
Gunshot wounds through arms –
while raising arms in front in a
defensive posture
Coup and Contra Coup Injuries
Coup
signifies that Injury site to
the injuries Impact site
brain
are located
beneath the
impact site
(usually
caused by
blow)
• Contra coup
injuries are
on the
opposite side Injury site to
from where
brain
the blow was
initiated (can
be caused by Impact site
fall)
• Coup – Contra Coup Injuries –
injuries are located both on the impact
site as well as the opposite side

• External injuries may be absent in

coup, contra coup or coup – contra
coup injuries
Burn Injuries
Severity of burns depends directly on
 Intensity of fire
 Duration of exposure
 Chemical fires may reach
temperatures of several thousand
degrees
 House fires seldom exceed 1200 F
(649 C), at this temperature it is
unlikely adult body will burn
completely
 Even though external body is charred
and unrecognizable, internal organs
are usually intact and liquid blood for
DNA, toxicology, and carbon
monoxide testing is present
• Teeth will usually be in excellent
condition for identification purposes
Clothed body burns more
completely than unclothed one

Area covered by
blanket
 Body of obese person will burn
more completely than thin person
because fat acts as accelerant
 When body is
exposed to heat,
muscles contract
and draw arms and
legs into bent
position
 This position has
been compared to
the stance of a
pugilist - boxer
 This burned position is
referred to as “pugilisticContracted
attitude” muscles of
upper & lower
extremities
Other Special Features of Burn
Victims:
 Heat Rupture - large, ragged tears in
skin due to heat contracture
Occur only in areas
severely affected
 Absence of brusing
or hemorrhage
• Heat Fracture - fractures of the skull
due to intracranially generated steam
and fracture of extremities due to
thermal contraction of tendons
• Difficult to distinguish from that
produced by blunt trauma
• Cranial vault may explode but the
base of the skull is not fractured
• Heat Hematoma – due to escape of
blood from skull diploe and venous
sinuses and settling in the extradural
space
• Blood is spongy in consistency and
brownish
Minutes of Effect on Body
Exposure to
Fire
10 Arms badly charred
10 – 15 Pugilistic Attitude
15 Face and Arm Bones Visible
20 Ribs and Skull Visible
30 Abdominal and Chest Cavities
Breached
35 Thigh Bones Visible
45 – 60 Base of Skull Exposed
45 – 150 Converted to Ashes and Bone
Asphyxiation
Asphyxia is a form of Anoxia (lack of
Oxygen):
• Anoxic Anoxia – lack of O2 in lungs
that cause insufficient oxygen delivery
to tissues – Ex: Choking, Smothering
• Anemic Anoxia – O2 is available but
blood is unable to absorb it – Ex: CO
poisoning
 Stagnant Anoxia – O2 is available
but blood cannot carry it to tissues
due to some form of failure in the
pumping mechanism or flow of
blood – Ex: Heart Failure, Embolism
 Histotoxic Anoxia – O2 is available
but tissues cannot absorb it – Ex: CN
poisoning
Causes of asphyxiation:
 Gagging
 Usually results
from forcing a cloth into
the mouth or the
closure
of the mouth and nose
by a cloth or similar
 Usually homicidal
material
 A gag pushed sufficiently deep
inside the mouth will cause
asphyxia.
 Initially, airway is patent thru the
nose but collections of saliva,
excessive mucus with edema of the
pharynx and nasal mucosa will
eventually lead to complete
obstruction of airways.
 Gagging is usually resorted to in
order to prevent a victim from
shouting for help and death is
usually unintentional
• Choking
 Occurs due to obstruction within
the air passages
Almost always accidental
 Usually occurs
during a meal due
to impaction of
large, solid bodies
such as a bolus of
food, piece of meat,
etc…
 Choking due to food
regurgitation may occur
in cases of rape or violent
sexual intercourse
 Head injuries may
irritate the brain causing
food regurgitation
 Foreign body is arrested
at or just below the vocal
cords
• Suffocation
 General term to indicate that form
of asphyxia which is due to
deprivation of oxygen
 May be due to lack of O2 in the
environment or due to obstruction
of air passages
• Environmental Suffocation
 Due to insufficient O2 in the
environment
 May be due to chemical or smoke
inhalation
 Smoke inhalation is
the no. 1 cause of
death in fires
 May be accidental,
suicidal or homicidal
 CO, HCN, H2S are
chemicals produced
by fire that can cause
chemical asphyxia
• Smothering
 Caused by closing the external
respiratory orifices either by hand or
by other means or by blocking the
cavities of the nose or mouth by the
use of a foreign object
 Suicidal smothering is almost
impossible
 Accidental smothering frequently
occurs e.g. infants lying-in with
parents, children playing with plastic
bags, mental patients, etc…
 Homicidal smothering – difficult to
detect at autopsy. History, crime
scene processing and circumstances
surrounding death must be known
• Asphyxia by Strangulation:
• Manual Strangulation / Throttling
 Asphyxia by
compression of the
neck using the hands
 Suicidal throttling is
impossible
 Homicidal throttling
in adults usually show
signs of struggle
 Assailant may sustain injury
 Pressure must be applied for > 2
mins to cause death
 Usual signs of throttling include:
1. Cutaneous bruising & abrasions
2. Extensive bruising with or without
rupture of neck muscles
3. Tissue engorgement at and above
the level of compression
4. Fracture of larynx, thyroid & cricoid
cartilage & hyoid bone
5. General signs of asphyxia
Hyoid
Bone
Thyroid
Cartilage
• Strangulation by Ligature
 Caused by compression of the neck
with a ligature without suspending the
body
 Usually done by pulling a U-shaped
ligature against the front and sides of
the neck while standing at the back
 Autopsy usually reveals hemorrhagic
edema of the lungs and increased
amount of secretion in the trachea
 Ligature mark around the neck is
usually horizontal in direction
 Hyoid bone may be fractured
(but less frequently compared to
hanging)
 Must be presumed to be
homicidal unless proven otherwise
 Asphyxia by HANGING
 Asphyxiation by
strangulation using
a rope, cord or any
similar material to
work against the
weight of the body
Death may come by any of 4 means:
1. Occlusion of carotids and
vertebral arteries
2. Base of the tongue is pushed
backwards and upwards inside the
neck thereby occluding the
nasopharynx
3. Direct laryngeal or tracheal
damage and occlusion
4. Cervical Fracture (Judicial or
Drop Hanging) causing damage
to the brainstem
Note: A person
does not have
to be fully
suspended to
hang
 When a victim
is found bound
or hung, the
bindings should
not be untied
 Bindings should
not be cut so
knots can be
preserved
 HANGING
1. Ligature mark is usually
above level of hyoid bone,
directed posteriorly and
obliquely upwards,
incomplete, with uneven
depth
2. May fracture hyoid bone
3. Inverted “V” mark is
usually present
STRANGULATION
1. Ligature mark is usually
below laryngeal
prominence, horizontal,
completely encircles neck
and depth of ligature is even
2. May fracture larynx &
hyoid (less frequently)
3. No inverted “V” mark
 A common outward sign of all the
forms of asphyxia by hanging or
strangulation is the presence of
petechial hemorrhages (Tardieu’s
Spots)
 They are typically found in and
around the eyes and cheeks
They are pinpoint capillary
ruptures visible on the skin and in
the eyes
They are caused by a build-up of
pressure as a result of asphyxiation
or strangulation
Tardieu’s Spots
• Traumatic / Crush Asphyxia
 Respiratory arrest due to mechanical
fixation and gross compression of the
chest by a powerful force
Normal chest
wall movements
are hindered
 Most cases are
due to accident
e.g. stampede,
etc…
 DROWNING is asphyxiation from
liquid or water being inhaled into
airways, blocking passage of air into
lungs
 As a person chokes and tries to breath,
frothy foam forms in the airway
 This foam may be white or white
with pink coloration
This foam coming from the mouth
and nose is an outward sign of
pulmonary edema
Electrocution
 Another form of death by
asphyxiation
 Shock may stop the heart or cause
ventricular arrythmia and oxygen will
cease to reach the brain
 Respiratory paralysis
 CNS damage / Brain Stem paralysis
 Burns
 Hemorrhage
 Electric current needed to cause
death depends on the quantity and
length of exposure as well as the part
of body affected
• Electrical
shocks may or
may not leave
marks on the
body (High
Voltage vs Low
Voltage)
• Involuntary limb muscle contraction
may lock the victim’s hand to the
electrified object and increase
exposure time
• Uncommon to encounter deaths at <
100 Volts
• Minimum of 9 seconds contact to
produce at least a 1st degree burn
• Typical mark is a shallow crater with
blistering, sometimes a break in the
skin and a faint rim of hyperemia
• Fatal electrocution can occur
without any skin or other injuries
whatsoever
 Lightning is a type of High Voltage
electrocution
 Death may result even without a
“direct hit”
 “Fern-like” or “Fan-like” arborescent
markings may be observed
 Injuries may be similar to those
found in blasting incidents
Gunshot Wound
 Gunshot wounds are typically
categorized by examining
characteristics of wound and looking
for the presence of gunshot residues
 Presence of gunshot residues is used
to determine approximate muzzle to
garment / target distance
Distance ranges are categorized as:
 Distant
 Intermediate
 Close
 Contact
 Loose
 Pressure
SKIN FINDINGS Pressure Loose Near Intermediate Distant
/ Loose Contact Contact Contact Fire
Contact up to >3” to 7” >7” to 24” > 24”
3”
IRONING (+) (-) (-) (-) (-)
BURNING/SEARING (+) (+) (-) (-) (-)
(scorching of the skin
by extremely hot gases
which come out of the
end of the gun barrel)
SMUDGING/SOOT (+) (+) (+) (-) (-)
(light, almost black by-
products of gunpowder
and other elements
with the propellant)
TATTOOING/ (+) (+) (+) (+) (-)
PEPPERING/
STIPPLING (unburned,
burning & partially
burned gunpowder
residue)
Source: Handbook of Forensic Pathology by Di Maio
Contact /
Close Intermediate Distant
Close contact
 When looking at gunshot residues,
it is important to remember that it is
not possible to accurately determine
distances without conducting tests
using the suspected firearm and
similar ammunition
• Distant wounds – firearm is too far
away to deposit residues on target
• Bullet wound is usually round
 If a bullet enters at an angle, there
may be an elliptical abrasion
around the hole
 ENTRANCE EXIT
Abrasion / Contusion Usually Without an
Collar Abrasion / Contusion
Collar
Edges Idented Edges Everted with Soft
Tissue/Organ
Evisceration
Usually Smaller in Size Usually Larger in Size
Usually Ovaloid to Usually Irregularly-
Circular/Regularly- Shaped
Shaped with a “Punched-
Out” Clean Appearance
Exceptions may occur in the
• Gunshot wounds to the skull
following:
(Stellate-shaped PoEn)
• Re-Entry Wounds
• Variables - position of the victim
when shot and type of firearm used
• Lax vs stretched skin in certain parts
of the body
• “Shored” exit wounds
 AUTOPSY IN THE PHILIPPINE
SETTING – FACTS & MYTHS
LEGAL PERSPECTIVE:
In the Philippines, the
only law governing the
conduct of an autopsy
upon the body of the
deceased lies with PD 856
– The Code on Sanitation
 Chapter 21
Section 91 – Burial Requirements
Paragraph F:
“If the person who issues a death certificate
has reasons to believe or suspect that the
cause of death was due to violence or crime,
he shall notify immediately the local autho –
rities concerned. In
this case the deceased
shall not be buried
until a permission is
obtained from the
provincial or
city fiscal…”
Section 95. Autopsy and Dissection of
Remains – The autopsy and dissection of
remains are subject to
the following require –
ments:
(a)Person authorized
to perform these are:
 1. Health officers;
 2. Medical officers of law enforcement
agencies; and
 3. Members of the medical staff of
accredited hospitals.
(b) Autopsies shall be performed in the
following cases:
1. Whenever required by special laws;
2. Upon orders of a competent court, a
mayor and a provincial or city fiscal;
 
3. Upon written request of police
authorities
4. Whenever the Solicitor General,
provincial or city fiscal as authorized
by existing laws, shall deem it
necessary to disinter and take
possession of remains for examination
to determine the cause of death; and
5. Whenever the nearest kin shall
request in writing the authorities
concerned to ascertain the cause of
death.
(c) Autopsies may be performed on
patients who die in accredited hospitals
subject to the following requirements:
1. The Director of the hospital shall
notify the next of kin of the death of the
deceased and request permission to
perform an autopsy.
2. Autopsy can be performed when the
permission is granted or no objection
is raised to such autopsy within 48
hours after death.
3. In cases where the deceased has no
next of kin, the permission shall be
secured from the local health
authority.
4. Burial of remains after autopsy:
After an autopsy, the remains shall be
interred in accordance with the
provisions in this Chapter.
 The public is exposed
to a wealth of forensic
pathology in the
media, particularly in TV
programmes such
as CSI, Law and Order, Silent witness
(UK) and The Closer.
However, these
representations
are rarely accurate.
Dr Charles Petty identified
popular Medico-Legal
misconceptions in an article
in 1971:
1. That the time of death can be
precisely determined by the
examination of the body.
2. That the autopsy always
yields the cause of death.
3. That the autopsy can be
properly carried out without a
“history” .
4. That embalming will not
obscure the effects of trauma
and disease.
5. That only true and
suspected homicide victims
need examination.
6. That the cause and manner
of death are the only results
of the autopsy.
7. That the autopsy must be
immediate.
8. That the poison is always
detected by the toxicologists.
 DETERMINATION OF DEATH
• Medical and legal significance
• Secondary therapeutic
implications
• Legal challenges related to
inheritance rights, estate
management, criminal liability
and tortual injuries
• Possible professional
involvement of the medico-
legal officer or forensic
pathologist
Philippine Criteria of Brain Death:
I. An individual who has sustained:
A. Irreversible cessation of
circulatory and respiratory
functions; or
B. Irreversible cessation of all
functions of the entire brain,
including the brain stem
CAUSE OF DEATH vs MANNER OF
DEATH:
• Cause of death pertains to a specific
disease or injury sustained by an individual
leading to his/her death;
• Manner of death pertains to the
mechanism by which death occurred and
carries with it the legal implications of
death.
EXAMPLES:
Cause of Death:
• Gunshot Wounds / Stab Wounds /
Hack Wounds to…
• Blunt traumatic injuries to…
• Myocardial Infarction / Intracerebral
Hemorrhage, etc…
EXAMPLES:
Manner of Death:
• Suicide
• Accident
• Natural
• Homicide
POSTMORTEM CHANGES AND
THE DETERMINATION OF THE
TIME OF DEATH
• Postmortem changes are important
due primarily to their sequential
nature which can be utilized in the
determination of the TIME OF
DEATH as well as in determining if
the body was MOVED after death.
• Determination of time of death is
based on the principle of using
these sequential changes as some
sort of a POSTMORTEM CLOCK
POSTMORTEM
• Refers to events or changes that
occur after death

ANTEMORTEM
• Refers to events or changes that
occur before death
 Postmortem Cooling (Algor Mortis)
• Liver and brain temperature is
measured
Rate of cooling depends on :
• Ambient conditions
(temperature, wind, rain, air)
• Weight of the body (mass :
surface area ratio)
• Body posture
• Clothing/coverings
LEVEL OF ACCURACY IS LOW!!!
(Must be used only in conjunction
with other PM changes.)
Postmortem Lividity (Livor Mortis):
 EARLIEST postmortem change
(Payne-James)
 Evident as early as 20 minutes after
death
 Due to the settling of blood by
gravitational forces
• Blood seeks the
lowest level within
the vascular
system
Blood settles on the
dependent parts of the
body due to
gravitational pull
 Areas of skin in
contact with a surface
may prevent livor from
discoloring the skin at
the point of contact
(may help determine if
cadaver was moved)
 Areas of scarring will
not have PML
 Livor mortis can also be useful
for determining if the body was
moved after death by looking at
lividity patterns on the skin
Color of lividity may serve as a DIAGNOSTIC
CLUE
ETIOLOGY COLOR MECHANISM
Normal Blue-purplish Venous blood
CO Pink,cherry-red Carboxyhemoglobin

CN Pink,cherry-red Cytochrome oxidase

inhibition
Fluoroacetate Pink,cherry-red Same as above

Refrigeration/ Pink,cherry-red O2 retention in cutaneous

Hypothermia blood by cold air.
Sodium chlorate Brown Methemoglobin
H2S Green Sulfhemoglobin
Postmortem Rigidity (Rigor Mortis)
 Second postmortem change and
sign of death (Payne-James)
 It develops and disappears at similar
rates in all muscles of the body (Spitz
and Fisher)
 Affects both voluntary and
involuntary muscles
 Locking chemical bridges between
actin and myosin filaments
 With decomposition of body
proteins, chemical bridges break
down - SECONDARY FLACCIDITY
 Affected by temperature, cause
of death, total body mass, drugs
and prior exercise
Becomes apparent within 30 minutes
to 1 hour; maximum within 12 hours;
remains for 12 hours (24hrs); and
disappears within the next 12 hours
(36hrs) (Spitz and Fisher)
• Its effect on involuntary muscles may
produce misleading artifacts - cutis
anserina (gooseflesh) due to rigor of
arrectores pilorum muscles; rigor on
occipitalis & frontalis muscles, and
nailbeds may simulate hair and nail
growth; rigor in muscles of the wall of
the seminal vesicles may cause
expulsion of semen
Cutis Anserina (Goose Bumps)
• Becomes more useful when used in
conjunction with other timing indices.
AVOID USING IT IN ISOLATION!!!
Body Temperature Stiffness of Body Time since
Death
WARM NOT STIFF < 3 HRS.

WARM STIFF BET. 3-8

HRS.
COLD STIFF BET. 8-36
HRS.
COLD NOT STIFF > 36 HRS.
 Rigor mortis is also a good indicator
of whether or not a person was moved
after the onset of rigor mortis
Occular Changes:
 Arrest of capillary circulation
with settling of RBC’s in a roleaux
pattern
When the eyes remain open, a thin
film is observed within minutes;
CORNEAL CLOUDINESS develops
within 2 -3 hours
If the eyes are
closed, corneal film
is delayed by hours;
Corneal cloudiness
may be delayed up to
24 hours or longer
• If the eyes remain open after death, the
areas of the sclera exposed to the air dry
out, which results in a first yellowish,
then brownish-blackish band like
discoloration zone called TACHE NOIRE
Spots.
• It is seen mostly
7 to 8 hours after
death
Absence of Intraocular Fluid
suggests time of death of AT
LEAST 4 DAYS
Stomach Contents:
 Based on the assumption that the
stomach empties at a known rate
• Affected by: amount and type of
food; drug, alcohol or medication
intake; prior medical, emotional or
psychological condition of the
deceased; age and body build of the
deceased; size of food particles and
the extent of mastication and the
nutritive density and osmolarity of
food
• Solid foods empty slower than liquid
foods. The greater the nutritive
density and osmolarity of a meal, the
slower the meal is transferred
The following emptying rates are given
in the literature (Payne-James):
 Light, small volume meal – 1 to 3
hours
 Medium-sized meal – 3 to 5 hours
 Large/heavy meals – 5 to 8 hours
• It has been found that stomach
contents which are readily identifiable
by the naked eye were usually ingested
within a two-hour period (Spitz and
Fisher)
 Digestion does not necessarily
stop at death but may progress
due to enzymatic activity,
therefore the state of digestion
of food is of little value (Payne-
James) in estimating the time
since death!!!
An ideal postmortem protocol of the rate
of gastric emptying should include:
 Nature, amount, size, and condition
of stomach contents
 Microscopic examination of the
contents if difficult to identify or
partially liquefied
 Examination of the small intestines
for undigestible markers
Toxicological examination of
stomach contents
Evaluation of the prior medical and
psychological status and related
medications
Note: The use of gastric contents as a
means of determining time of death
requires caution and careful review of
all limiting factors
DECOMPOSITION
Arrest of biochemical processes
which preserve the integrity of
the cellular and subcellular
membranes and organelles
Two parallel processes (always
occurs):

Autolysis – self-dissolution by
body enzymes

Putrefaction – action of bacteria

and microorganisms
A third process, ANTHROPOPHAGY,
(Greek for “eating of man”) may or
may not occur
Autolytic Changes:

 Early autolytic changes occur in

organs rich in enzymes such as the
pancreas, gastric mucosa, and liver
• Gastromalacia is the
autodigestion of the gastric mucosa
with perforation, usually occurring
in the fundus of the stomach

• Esophagomalacia is a similar
process which involves the lower
portion of the esophagus
Putrefaction:
 Dependent primarily on
environmental temperatures and the
prior state of health of the individual
 Fever - accelerates decomposition
and putrefaction
 Obesity accelerates putrefaction;
delayed in infants and thin
individuals
Accelerated in edematous or
exudative areas of the body; delayed
in dehydrated tissues
Exposure to cold or refrigeration
delays putrefaction; accelerated in
postmortem thawing
Putrefaction gasses include
methane, CO2, H2 and particularly
malodorous ammonia, H2S and
mercaptans
 24 – 30 hours

Greenish discoloration of the abdomen; gaseous

bloating;dark greenish to purple discoloration of
face; bloody decomposition fluids from nose and
mouth (PURGE)
36 – 48 hours
MARBLING pattern
72 hours
Markedly bloated; “Glove-like” and “stocking-like”
pattern
18 months
Full skeletonization
Purging of body fluids
Purging of body fluids
Purging of body fluids
 STAGE DESCRIPTION

Initial Decay Cadaver appears fresh externally but decomposing

internally due to parasite & bacterial activity in the
body before death.

Putrefaction Cadaver swollen by gas produced internally with odour

of decaying flesh.

Black Putrefaction Flesh of creamy consistency with exposed parts black.

Body collapses as gasses escapes. Odour of decay
very strong.

Butyric Fermentation Cadaver drying out. Some flesh remains at first and
cheesy odour develops. Ventral surface mouldy
from fermentation.

Dry Decay Cadaver almost dry; Slow rate of decay.

Postmortem Artifacts:
 Faulty autopsy techniques such as
careless removal of congested neck
organs, prying the skull with a chisel
or by sawing, etc… creates confusion
in the postmortem examination of a
body
Factors that may obscure, modify, or
mimic genuine antemortem injuries:
 Fire victims:
 Fractures of the skull and epidural
hemorrhage due to intracranially
generated steam
 Fracture of extremities due to thermal
contraction of tendons
 Wide splitting of skin and muscles may
mimic lacerations
• Frozen bodies:
 Folding of the skin of the neck may
mimic ligature strangulation
 POSTMORTEM MIMIC
Bloating Obesity
Purging of decomposition fluid from Premortem trauma
mouth and nose
Decomposed body fluid in the chest Hemothorax
Agonal or postmortem autolysis and Perforated ulcer
perforation of stomach
Dilatation and flaccidity of vagina and Sexual attack or sodomy
anus
Pinpoint foci of extravasated blood from Petechial hemorrhages
burst capillaries in areas of intense
livor
Diffusion of hemolyzed blood into tissues Premortem bruising
in areas of livor
Focal autolytic changes in pancreas Focal necrosis or
hemorrhagic pancreatitis