ADVENTIST UNIVERSITY OF THE PHILIPPINES

COLLEGE OF HEALTH
Medical Laboratory Science Department
Histopathologic & Cytologic Techniques

POST MORTEM CHANGES

Introduction

After death, a sequence of changes naturally occurs in the human body. Although these changes proceed
in a relatively orderly fashion, a variety of external factors and intrinsic characteristics may accelerate or
retard decomposition. Understanding common postmortem changes and the variables that affect them
allows the forensic pathologist to more accurately estimate the postmortem interval (PMI) and to provide
a time frame during which death occurred. Further, an awareness of common postmortem artifacts limits
the risk of misdiagnosis at the time of autopsy.

History

Death and the changes that follow have been ingrained in society since the dawn of history. Ancient
Egyptians took extraordinary measures to slow decomposition, with some good results. Later societies
recognized the need to sequester the dead from the living to contain the spread of disease. In modern
times, bereaved families must choose between cremation and embalmment for their dearly
departed. Death is a part of life, and decomposition is a part of death.

Epidemiology

All bodies undergo some degree of postmortem change after death. Change begins at the molecular level
and sequentially progresses to microscopic and gross morphology.

Overview of the Entity

Postmortem changes begin soon after death and progress along a timeline. Two processes, putrefaction
and autolysis, begin to alter the body; either one may predominate, depending on the circumstances
surrounding death, as well as the climate. Putrefaction involves the action of bacteria on the tissues of
the body. This process, prevalent in moist climates, is associated with green discoloration of the body;
gas production with associated bloating; skin slippage; and a foul odor.

Autolysis is the breakdown of the body by endogenous substances. It proceeds most rapidly in organs
such as the pancreas and stomach. It may predominate in more arid conditions and can eventually result
in mummification.

In most circumstances, autolysis and putrefaction occur in tandem. In temperate climatic conditions, they
can result in rapid degradation of the tissues. These alterations may eventually produce great distortion
of the body after death, hampering the interpretation of the postmortem findings but not ameliorating
the value of the autopsy.

Some of the more well-known postmortem changes, such as rigor mortis, livor mortis, and algor mortis,
progress on a relatively set schedule; however, many external and intrinsic factors may affect their
development. It should be remembered that the estimated period for the arrival and passage of these
manifestations of the decomposition process is based on studies under very controlled conditions,
including a temperate climate (ie, 75° F).

In reality, many deaths occur outside of these “ideal” settings, and additional confounding variables may
be present (eg, layered clothing, obesity, fever). Further, the longer the PMI, the less accurate the PMI
estimate becomes.

1. RIGOR MORTIS

Rigor mortis is the postmortem stiffening of the body’s muscles. It may or may not involve some
degree of actual shortening of the muscles. In most cases, rigor mortis begins within 1-2 hours after
death; it begins to pass after 24 hours.

Rigor mortis develops as the body’s energy source (adenosine triphosphate [ATP]) is depleted. Muscle
fibers require ATP for relaxation; once depleted, actin and myosin proteins remain complexed, resulting in
stiffening of the muscles. Rigor mortis is thought to develop in all muscles simultaneously; however, it is
most evident first in the smaller muscle groups, such as the jaw, after which rigor mortis typically occurs
in the upper extremities and then the lower extremities, as in the following image.

Rigor affects both smooth and skeletal muscles, including the myocardium (simulating hypertrophy), hair
follicles (resulting in cutaneous "goose bumps"), and seminal vesicles (resulting in postmortem semen
release from the penile meatus).

Rigor mortis first appears approximately 1-2 hours after death. Progressive stiffening occurs for
approximately 12 hours, persists for approximately 12 hours, then diminishes over the next 12 hours as
tissues break down as a result of autolysis and putrefaction.

Rigor mortis may be used to deduce the position of the decedent if the body has been moved after the
development of rigor mortis. If rigor mortis is broken by manipulation before becoming fully fixed, it may
reform in the new position.

The estimation of the strength of rigor mortis is often rated on a scale of 0–4 and is highly subjective.

Cadaveric spasm is an uncommon and disputed form of rigor that develops immediately upon death,
usually after strenuous activity. One theoretical example would be a drowning victim’s hand clutched
around a swatch of grass growing on the water’s edge. In such cases, it is presumed that the decedent
was in profound lactic acidosis at the time of death as a result of violent struggle and went into rigor
mortis immediately.
2. LIVOR MORTIS

Livor mortis is the purple-red coloration that appears on dependent portions of the body other than
areas exposed to pressure after the heart ceases to beat. It results from the settling of the blood under
the force of gravity.

Livor mortis usually appears 30 minutes to 2 hours after death, though it may appear sooner in cases
of severe heart failure in which the antemortem circulation was sluggish. After a PMI of 8–12 hours, red
cells extravasate from the vessels into the surrounding soft tissue. Until that time, the application of
pressure to an area of livor will result in blanching of the skin.

After that period, livor may blanch with forceful pressure but will ev entually not blanch, at which time it is
considered fixed. Movement of a body before the complete fixation of livor will result in the redistribution
of lividity into the newly dependent areas of the body. If there is partial fixation of the livor at the time
the body is moved, it is to be expected that the original pattern of distribution of residual livor would
remain.

Livor mortis also affects the organs; it is often most appreciated in the lungs, which appear congested in
dependent areas. In appearance, livor may differ markedly from case to case. It may be difficult to
discern lividity in darkly pigmented individuals and in cases in which near exsanguination has occurred.

Livor has become particularly important in determining the postmortem position of infants (eg, prone
sleeping position) when first responders have moved the decedent before the arrival of agency
investigators. As breakdown of tissues, including the vasculature, progresses, red cell extravasation into
the soft tissues may actually simulate antemortem hemorrhage, as demonstrated in the image below.
Differentiation is made in the context of the location and pattern of the discoloration and the events
surrounding the death. In some cases, it may not be possible to differentiate antemortem tr auma from
postmortem artifactual effects.

Tardieu spots are petechiae and purpuric hemorrhages that develop in areas of dependency,
hence, in areas of livor. They occur secondary to the rupture of vessels under the influence of increased
pressure from gravity in conjunction with vascular breakdown. Classically, they are seen in cases
involving hangings; they appear on the lower legs of individuals who have been fully suspended,
although they may be seen in any area of dependency.
3. ALGOR MORTIS

Algor mortis is the process by which the body cools as heat production ceases and body heat is lost to
the environment. Bodies in which the ratio of the surface area to body mass is large cool more quickly
(eg, bodies of thin people and infants cool more quickly than bodies of obese persons).

A general rule of thumb is that the body loses heat at an average of 1.5°-2° F during the first 12 hours
after death. However, the rate of cooling is dramatically affected by the circumstances of death, most
significantly, by the environmental and body temperatures. A body will only cool to the environmental
temperature; a body lying in 105° F during the summer would not be expected to cool at all —in fact, in
such circumstances, the body’s temperature would increase.

Other significant factors affecting algor mortis include the body location (eg, shade versus sun), clothing,
and the habitus of the decedent. A cold tile floor would promote body cooling as a result of conduction.
Obese individuals and heavily clothed individuals would be expected to lose heat more slowly.
Approximate times for algor and rigor mortis in temperate regions

Body Temp Body Stiffness Time Since Death

Decomposition is the process by which tissues of a dead organism break down into simpler forms of
matter. The process is essential for new growth and development of living organisms because it recycles
the finite matter that occupies physical space in the biome. The bacterial flora disseminates, owing to the
fact that the body no longer has a functional immune system. The abdomen develops a green
discoloration after 24–36 hours, usually in the right lower quadrant first (the location of the microbe-
laden cecum). Bodies of living organisms begin to decompose shortly after death.
It is a cascade of processes that go through distinct phases. It may be categorized in two stages by the
types of end products:
1. Formation of liquid materials (flesh or plant matter begin to decompose).
2. Production of vapors.

The science which studies such decomposition generally is called taphonomy from the Greek word taphos
- which means grave.

Besides the two stages mentioned above, historically the progression of decomposition of the flesh of
dead organisms has been viewed also as four phases:
1. fresh (autolysis),
2. bloat (putrefaction),
3. decay (putrefaction and carnivores) and
4. dry (diagenesis).

5. PUTREFACTION

Odor, color changes, and bloating of the body during decomposition are the results of putrefaction. The
lower part of the abdomen turns green due to bacteria activity in the cecum. Bacteria break down
hemoglobin into sulfhemoglobin which causes the green color change. A formation of gases enters the
abdomen which forces liquids and feces out of the body. The gases also enter the neck and face, causing
swelling of the mouth, lips, and tongue. Due to this swelling and misconfiguration of the face,
identification of the body can be difficult. Bacteria also enter the venous system causing blood to
hemolyze. This leads to the formation of red streaks along the veins. This color soon changes to green,
through a process known as marbelization. It can be seen on the shoulders, chest and shoulder area, and
thighs. The skin can develop blisters containing serous fluid. The skin also becomes fragile, leading to
skin slippage, making it difficult to move a body. Body hair comes off easily. The color change of the
discoloration from green to brown marks the transition of the early stage of putrefaction to the advanced
decompositional stages.

2 Chemicals produced during putrefaction:

Rule of thumb:
1 week of putrefaction in air
2 weeks in water
8 weeks buried in soil

7 days after death most of the body is discolored

2nd week after death abdomen, scrotum, breasts & tongue swell
the eyes bulge out

3-4 weeks after death hair, nails, and teeth loosen