Source (Europe PMC)

Fig 1: Large irregular and deep laceration on the front of the head.
Fig 2: Deep and irregular laceration on the left side of the top of the head.
Fig 3: Compound fractures under each laceration.
Fig 4: Some of the fragments were not in place in the reconstruction of skull cap.
Fig 5: Radiating fractures extending to the base of skull, from the anterior cranial fossa to the middle cranial fossa, incorporating the sphenoid bone, ethmoid bone, and sella turcica.
Fig 6: A shrapnel found lodged in the mid aspect of its origin—in the rim of the temporal fossa of the skull.
Fig 7: A shrapnel (metal ball measuring 0.5 cm in diameter).
Fig 8: Brain parenchyma showing lacerations on the frontal and parietal lobes.
Fig 9: Multiple underlying contusions on bilateral frontal white matter.
Fig 10: Brain laceration was associated with localized subarachnoid hemorrhage.
Fig 11: Penetrating irregular laceration, running diagonally on the right ear, involving the triangular fossa.
Fig 12: Duplicate of Fig 9 cause retarded LiveGore won't let me add thhumbnails

The deceased was a 15-year-old girl who was participating in the Easter mass at St. Sebastian’s Church—Katuwapitya, Negombo—when a suicide bomber entered the church and blew himself up, killing over hundred and injuring and permanently disabling many more. Following the explosion, the mother of the deceased noticed the deceased being rushed to the hospital in a car. However, she was pronounced dead on admission.

Pre autopsy radiology revealed spherical shrapnel in the temporal region (Figure 12). The injuries that are of value in analyzing the injury pattern and those that will help to reconstruct the event are described below, very briefly. The exact dimensions and accurate anatomical locations are not being described.

There was a large irregular and deep laceration on the front of the head ( Figure 1 ), with its midpoint roughly 7 cm above the glabella and another deep and irregular laceration was observed on the left side of the top of the head ( Figure 2 ). The surfaces of the scalp beneath these injuries were severely contused. Under each of these lacerations were compound fractures ( Figure 3 ). Upon reconstruction of the skull cap, some of the fragments were not in place ( Figure 4 ). Few fragments were embedded in the brain parenchyma. The skull bone between the abovementioned compound fractures were also fragmented, therefore for convenience these two fractures are considered as one whole compound fracture. Inner beveling was noticed from 4 o’ clock to 7 o’ clock position and outer beveling was noticed from 12 o’ clock to 2 o’ clock position giving rise to a keyhole lesion. There were radiating fractures from 12 o’ clock, 5 o’ clock, 7 o’ clock, 8 o’ clock, and 10 o’ clock positions. The fracture radiating from the 7 o’ clock position ran downward and inward into the right orbit and toward the base of skull and extending from the anterior cranial fossa to the middle cranial fossa, incorporating the sphenoid bone, ethmoid bone, and sella turcica ( Figure 5 ). The coronal suture intersecting the compound fracture showed features of sutural diastasis.

Internal examination revealed an extensive dural tear underlying the compound fracture. Upon reflection of the right temporalis muscle, a shrapnel (metal ball measuring 0.5 cm in diameter) was found lodged in the mid aspect of its origin—in the rim of the temporal fossa of the skull ( Figures 6 and 7 ). The brain was grossly edematous with brain parenchyma showing lacerations on the frontal and parietal lobes ( Figure 8 ). There were multiple underlying contusions on bilateral frontal white matter ( Figure 9 ). The brain laceration was associated with localized subarachnoid hemorrhage ( Figure 10 ). Small subarachnoid hemorrhage was noted on the basal aspect of the brain.