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Forensic examination after exhumation: Contribution and difficulties after
more than thirty years of burial
Article in Journal of Forensic and Legal Medicine · October 2016
DOI: 10.1016/j.jflm.2016.10.005
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Journal of Forensic and Legal Medicine 44 (2016) 120e127
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Short communication
Forensic examination after exhumation: Contribution and difficulties
after more than thirty years of burial
Y. Nouma a, b, *, W. Ben Amar a, b, M. Zribi a, b, S. Bardaa a, b, Z. Hammami a, b, S. Maatoug a, b
a
b
Forensic Department, University Hospital Habib Bourguiba, Sfax, Tunisia
Faculty of Medicine of Sfax, University of Sfax, Tunisia
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 4 December 2015
Received in revised form
19 September 2016
Accepted 8 October 2016
Available online 11 October 2016
We report a case of a Tunisian footballer who was found dead abroad under suspicious circumstances.
The cause of death was, originally, attributed to a lightning strike. The corpse was buried without/autopsy. Over thirty years later, the family requested the exhumation to verify the identity and the cause of
death. The exhumation was performed in 2011. DNA profiling from teeth and femur bone samples
confirmed the identity of the deceased. The dry bone study revealed defects in the skull and the pelvis
evoking firearm injuries. Post-mortem CT with three-dimensional (3-D) reconstruction allowed to
confirm the characteristics of firearms injuries and to speculate about the number and the trajectories of
potential shots. Nevertheless, the vitality of these injuries as well as the eventual fatal shot and the
shooting distance could not be determined. Likewise, the type of the eventual weapon could not be
clarified as there were no bullets or any metallic projectile fragments. Despite all doubts, the forensic
explorations have allowed to verify the identity of the deceased, to evoke firearms injuries and, mainly, to
deny the proposed cause of death after more than thirty years of burial. Moreover, the loss of soft tissues
and bone fragility were the major obstacles.
© 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords:
Exhumation
Forensic autopsy
Post-mortem imaging
Skeletonization
Firearm injuries
Ballistics
1. Introduction
2. Case report
The forensic examination after exhumation is one of the most
complicated situations that confront the forensic pathologist.
Formerly, it was considered as slightly contribute mainly in case of
putrefied corpse.1 Thanks to advances in technology and scientific
knowledge, currently applied in forensic medicine, like medical
imaging, genetics and biology, it is established that this examination can provide valuable information concerning the corpse's
identity and the cause of death.2,3 Nevertheless, forensic examination of an exhumed corpse, long period after burial, is still delicate and faces many obstacles. Corpse decomposition makes it
difficult to examine the body itself and hinders the findings'
interpretation as well.
In this paper, we present an unusual case of exhumation performed more than thirty years after burial. We try to discuss the
contribution of this forensic examination and to illustrate the major
difficulties.
We report a case of a 32 year-old Tunisian footballer, who was
found dead abroad in 1979. At that time, the death was explained
by a lightning strike that occurred during a football training session.
The corpse was repatriated to Tunisia, inside a sealed coffin, under
special security conditions. It has been sent directly to the cemetery
and buried without an autopsy. After a short time, rumours of a
possible murder by firearm shots began to arise.
In 2011, after the fall of the former political regime in Tunisia, the
family has requested the exhumation to remove doubt about the
cause of death. Then, exhumation and forensic examination were
ordered by the judicial authorities with a mission to verify the
cause of death and the identity of the deceased. The exhumation
was conducted with the presence of the pathologist required to
perform the forensic examination. Upon opening the tomb, there
was a dilapidated coffin in wood (Fig. 1a). The corpse was found in a
plastic hermetically sealed bag (Fig. 1b). This bag was extracted and
sent to the forensic department for examination.
* Corresponding author. Forensic Department, University Hospital Habib Bourguiba, Sfax, Tunisia.
E-mail address: docyoussef@live.fr (Y. Nouma).
http://dx.doi.org/10.1016/j.jflm.2016.10.005
1752-928X/© 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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121
2.1. Dry bone study
In the bag, bones were found lying in mud (Fig. 1b). The skin,
musculoskeletal system and internal organs were absent due to
extensive decomposition and body changes. Bones were washed
and slimy substance surrounding them was sieved. Overall, it was
possible to reconstitute a complete human skeleton measuring
172e176 cm in length (Fig. 1c). There was black curly hair
measuring 6e7 cm in length covering the skull (Fig. 2). On the
crane, we found:
- A first round orifice in the left temporal bone (Fig. 3 a,b),
- A second round orifice in the right orbit,
- A bone defects in the roof and the outer wall of the left orbit and
the left zygo-maxillary region separated from the first orifice by
a bone bridge, that dropped during the examination because of
bone fragility (Fig. 3 c,d),
- A total lack of the left ascending branch and the left angle of the
mandible with a small depressed area of the bone's outer table
directed from outside to inside, anterior to posterior and from
right to left (Fig. 4 a,b),
Furthermore, we found large bone defects in the upper and
anterior portion of the right ilium bone, measuring 80 mm in major
axis, combined with a wide hulling area on its inner table (Fig. 4
c,d).
Afterwards, we performed a series of investigations, including
post-mortem imaging and genetic analysis, to accomplish our
mission. However, other available analysis (toxicology, histology,
chemistry, etc.) was not performed whereas the extended postmortem period (32 years).
2.2. Post-mortem imaging
Post-mortem X-ray has shown bone defects described by the
external examination (Fig. 5). No other fractures or metal debris
were revealed. Using a helical multi-slice CT, post-mortem imaging
of the skull has shown:
Fig. 2. Black hair measuring 6e7 cm in length covering the skull.
- A well defined round orifice in the inner wall of the right orbit
measuring 25 mm in diameter (Fig. 6a),
- Extensive bone fractures in the right maxillary sinus and the left
zygo-maxillary region measuring 46 mm in diameter (Fig. 6 b,d),
- A round orifice in the anterior segment of the nasal wall
measuring 13 mm in diameter associated with a wide hulled
area (Fig. 6c),
- The absence of the left ascending branch and the left corner of
the mandible just facing the thirty eighth molar,
- Multiple fractures in the anterior floor of the base of the skull
essentially on the roof of the left orbit (Fig. 6b,d),
Fig. 1. (a) Situation at the place; (b) Corpse found in mud inside a plastic bag; (c) Complete human skeleton after reconstruction.
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Y. Nouma et al. / Journal of Forensic and Legal Medicine 44 (2016) 120e127
Fig. 3. Dry bone study: (a, b) Round orifice in the left temporal region; (c, d) Bone defects in the left orbit, the left zygo-maxillary region and the base of the skull.
Fig. 4. Dry bone study: (a, b) Bone defect in the mandible with a depressed area of the bone's outer table (white arrow); (c, d) Bone defect in the upper and anterior part of the right
Ilium combined with a wide hulling area (black arrow).
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- A medium density precipitation in the occipital region of the
cranial vault containing bone fragments which measure 10 mm
for the largest one (Fig. 6b).
In addition, 3-D reconstruction allowed to demonstrate the
bone defects, especially, in the left facial and temporal regions
(Fig. 7) and to speculate on the number of the eventual shots and
their trajectories.
2.3. Genetic analysis
The genetic study consisted of a comparative DNA analysis to
verify an eventual paternity. Then samples taken from the teeth and
the femoral bone of the corpse were compared with blood samples
from the alleged son of the deceased. We proceeded to the study of
12 genetic markers and the Y-chromosome by using polymerase
chain reaction (PCR) amplification and short tandem repeat (STR)
typing. We found that the deceased is the biological father with a
paternity probability equal to 99.41697%.
3. Discussion
Exhumation refers to the recovery of a previously buried body
for post-mortem examination.4 It often occurs several days to
months after burial.5 Some exhumation studies reported time of
burial varying from 5 days to 20.5 years.3,5 However, it is rarely
performed many years after interment.3,5
The forensic examination after exhumation is the last resort for
the forensic diagnosis of an unexplored or improperly explored
death.4 Its frequency is variable in the world and depends on
various factors, particularly cultural, political and religious convictions.6,7 Unlike many other countries that have a well-defined time
limit up to which exhumation can be done, in Tunisia there is no
time limit for ordering of the exhumation. Even so, pursuant to the
17th section of the law n 97-12 concerning cemeteries and burial
sites, it may be performed only after permission of the competent
judicial authority.8 Following new information, it may be requested
by the family to verify the identity of the deceased, to determine
the circumstances and the cause of death4,9,10 or at least to deny
recent information about death (rumours, witness statements,
etc.).11
Compared with conventional autopsy, done immediately after
123
death, forensic examination on an exhumed corpse usually encounters problems.7,12 Then, the question of its possible utility
should always be discussed before any exhumation.4 Previously, it
needs to define the situation and decide whether the necessary
information may still be detectable after the burial period.13,14
Although, even negative information gained by exhumation can
be useful in some cases.4
The success of any exhumation depends not only on the technical means available to accomplish the requested mission, but also
on the conservation conditions of the corpse (duration and conditions of burial, environmental influences).4,9,10,15 After a short burial
time, the success rate of exhumation for medico-legal purposes
varies from 66%5,7e78% of cases.14 This is less likely possible after a
long period of burial.3 The major determining factors for a possible
outcome at exhumation are, essentially, the absence of soft tissue,
the identification of the ante-mortem or post-mortem character of
the lesions and the exposure to environmental and taphonomic
factors.14
In our case, over thirty years of burial, it was already expected
that the corpse is in a form of skeletonized remains. According to
the literature, the corpse skeletonization is estimated to occur between four years to more than 10 years.16e19 The skeleton examination differs widely from the examination of a well preserved
corpse.4 Indeed, in case of firearm injuries, soft tissues provide
interesting information. Skin is the seat of specific lesions that
permits to affirm the ballistic nature of the trauma, to differentiate
the inlet and outlet orifices, to estimate the shooting distance and
to define the shooting direction.20,21 The body organs can also be
the site of ballistic trajectories without any bone damage.20
Moreover, one of the most challenging steps in the analysis of
skeletal trauma is distinguishing between ante-mortem and postmortem injuries. In practice, this differentiation is difficult.22
Recent studies have attempted to define variables to distinguish
secondary trauma induced by environmental factors.23,24 It is
described that these secondary lesions have discoloured edges
compared to the rest of bone surfaces.25 As well, other studies have
been conducted to determine precisely the morphological characteristics of bone trauma.26,40 However, it may often be difficult to
distinguish an ante-mortem of a post-mortem lesion. Some antemortem fractures can develop over time post-mortem characteristics like colour modification or edges rounding. Likewise, postmortem lesions can mimic vital lesions.26,27 The buried corpse
Fig. 5. Post mortem X-ray exams showing bone defects.
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Y. Nouma et al. / Journal of Forensic and Legal Medicine 44 (2016) 120e127
Fig. 6. Post-mortem CT: (a) Well defined orifice in the inner wall of the right orbit; (b, d) Extensive fracture in the right maxillary sinus; (c) Orifice in the anterior segment of the
right nasal wall; (b, d) Multiple fractures in the base of the skull with a precipitation (40 HU) in the bottom of the cranial vault containing bone fragments (white arrow).
Fig. 7. 3D-reconstruction of the skull showing details of bone defect.
undergoes several changes from mechanical and chemical erosion
due to the soil and the action of predators and plants.28 Although, in
our case, the corpse has been relatively protected from environmental factors considering the burial conditions, Knight described
a skeleton completely disintegrated in the coffin because of the soil
conditions.28 Even though our mission was qualified difficult from
the beginning, we have proceeded to the verification of the
deceased identity and the determination of the cause of death.
3.1. Identity of the deceased?
After thorough anthropological examination of skeletal remains
we concluded that bones examined belong to an adult male having
a minimum size of 170 cm. This profile, with the hair
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correspondence, is consistent with the footballer profile. Formal
identification was provided by genetic analysis.
Although, genetic analysis is the method of choice for forensic
identification, the anthropological evaluation remains so contributors. A common problem with DNA analysis is the preservation of
genetic material. The decomposition by bacteria or other microorganisms and the exposure to environmental agents (humidity,
organic compounds, etc.) may cause post-mortem DNA degradation.29 Then, it is confirmed that bones and teeth samples are very
useful in DNA analysis because of their long preservation.30e33
3.2. Cause of death?
Unlike the well-preserved corpse, available information on
skeletal remains is rarely used to precisely reconstruct a lethal
event. Nevertheless, signs of trauma may persist in the bones.34 In
our case, the forensic examination has identified bones lesions in
two different locations, skull and pelvis. We did not find any other
fracture or metallic foreign object. The observed lesions included
round and well defined orifice in the skull, multiple fractures in the
base of the skull, large defect in the lefts facial bones and defect in
the right ilium bone with a large hulled area directed from outside
to inside.
A traumatic event on bones is generally classified as the result of
driving forces effect and projectile, blunt object or sharp instruments impact.35 Generally, all of these agents generate specific
skeletal signs that are easily identified in the immediate postmortem. On skeletal remains, the interpretation of these signs
could be doubtful.
In our case, the proposed cause of death was a lightning strike.
Lightning is a transfer of an electrical charge resulting from the
125
sudden environmental discharge of static electricity.36 Then,
lightning injuries result from electrical shock, thermal energy or an
enormous blast force.37 These lesions are often in the form of firstand second-degree burns to the skin.38 In addition, victims may be
thrown by the concussive forces of the strike and get secondary
injuries.39 Particularly, bone fractures (long bones, skull and cervical spine) may be caused by the intensive muscle contraction or
even by an associated blunt trauma.37e40 They are generally linear
without any bones defect.41 Likewise, blunt force impact on the
upper temporal or parieto-temporal areas causes, in general,
fissured fractures which run obliquely downwards across the
temporal area.42 As considering the aspect of fractures and bone
defects, it is obvious that lesions, described above, cannot be
explained by a lightning entry or exit injuries. In addition, they
cannot be caused by a blunt object or a sharp instrument. However,
they are consistent with firearm injuries. In such cases, innovative
applications of radiology are very useful. 3-D computerized imaging, often used in case of cranial and facial fractures in skeletal
remains, allows refining fracture measurements, detail patterns of
trauma and showing trajectory paths involving multiple injuries.
This method has also the potential to be used in the validation of
bullet trajectories.42,43
Based on correlating findings of dry bone study and postmortem imaging, we can conclude that:
In the skull: there were probably two separate shots:
- The first shot would be gone from the inner wall of the right
orbit causing a small rounded orifice. Then, the projectile
would have perforated the nasal wall, causing an extensive
bone hulling. The blast wave would have caused multiple
fractures of the skull base and the right maxillary sinus. Then,
Fig. 8. Two potential shots in the face's bones and the possible bullet paths (black arrow): (a,b) first shot, (c,d) second shot.
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Y. Nouma et al. / Journal of Forensic and Legal Medicine 44 (2016) 120e127
References
Fig. 9. The potential shot in the pelvis and the possible bullet path (white arrow).
the projectile would be coming out of the left temporal region
(Fig. 8 a,b).
- The second shot would have gone from the left horizontal
portion of the mandible as demonstrated by the depression in
its outer table. Then, it would have destroyed the angle and
the left ascending branch of the mandible, the outer wall of
the left orbit and the left zygomatic bone (Fig. 8 c,d).
In the pelvis: It was probably a single shot, directed from back to
front and from outside to inside as demonstrate the bone hulling
direction (Fig. 9).
Although the ballistic mechanism of bone lesions is strongly
raised, we couldn't determine whether it was carried out in the
ante-mortem or post-mortem time. As no foreign object was found,
the projectiles would have probably left the body. In addition, there
were, maybe, other shots that did not affect the bones and cannot
be identified on skeletal remains. Anyway, if the shots were vital,
they would be certainly fatal.
4. Conclusion
After a long period of burial, determination of the cause of death
persists difficult. It depends on the post-mortem interval and the
burial conditions. In our case, forensic examination has confirmed
the identity of the corpse and, mainly, denied the proposed cause of
death. Firearm shots hypotheses were heavily discussed. Potential
injuries would be certainly fatal if they were vital. The exact
number of shots and the type of weapon used could not be determined. In fact, this has been limited by the absence of soft tissues,
bone fragility and the absence of the projectile. Nevertheless, even
without a formal conclusion, exhumation has brought great satisfaction to the family of the deceased, who was finally able to
approach the truth behind his death.
Conflicts of interest
None.
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