The "Hands of Blue" (Firefly) use a special sonic weapon...
...to liquefy a victim's internal organs, causing blood from every orifice.
Chiaotzu (Dragon Ball) uses Telekinesis
to attack Krillin's internal organs.
Oboro (Gintama) using Hakkei to strike Gintoki's pressure points, causing a disruption of the meridian flow and his leg to burst from the inside.
Utsuro (Gintama) using Hakkei to strike Kagura's pressure points, causing a disruption of the meridian flow, which leads to internal damage.
Using Sai Dai Rin: Rokuogan, Rob Lucci (One Piece) produces a powerful shock wave that causes serious internal damage.
Trafalgar D. Water Law (One Piece) using Gamma Knife, which bypasses any defenses to directly rupture the target's internal organs, making it almost impossible to survive.
Usopp (One Piece) using a Impact Dial on Luffy causing internal damage even though his made of rubber.
Wyper (One Piece) using a Reject Dial on Shura hitting him with 10x more the power of an ordinary Impact Dial.
Those who have advanced their Busoshoku Haki (One Piece) from emitting their haki without using a medium, but send it inside of their target to destroy them from the inside-out.
D.L. Hawkins (Heroes) kills Daniel Linderman by phasing his hand into his head and destroying his brain.
Judge Death's (2000 AD) preferred method of killing is phasing his hand into a victim's chest and crushing their heart.
Chris Halliwell (Charmed) uses telekinesis...
...to crush a Valkyrie's heart.
The Hyuga Clan's (Naruto) Gentle Fist techniques attack the victim's internal organs and chakra network directly.
Kabuto (Naruto) can use Chakra Scalpel to cause internal cuts of his victims.
Scar (Fullmetal Alchemist) typically uses his right arm's destructive power to attack his opponent's organs.
Superman (DC Comics) is able to perform such feats as lobotomizing others without leaving an external mark through careful focus of heat vision
Justice Lord Superman (Justice League Unlimited/DC Comics) using his heat vision to lobotomize
Using his heat vision
and x-ray vision
, Superman (DC Comics) destroys the anomaly in Manchester Black's brain that grants him his powers.
The Leprechaun (Leprechaun series) can use his magic to make a victim's heart or insides explode from the inside out.
Diclonii such as Lucy (Elfen Lied) are able to cause precise internal injuries, such as heart attacks or collapsing blood vessels, through careful focus and precision of their vectors.
Muromi (Muromi-san) can break all the bones of anyone from the inside out just by placing her hand on their chest....
...demonstrating by breaking all of an animals bones from the inside.
Castiel (Supernatural) smiting Lenore.
Eligos (Ash vs. Evil Dead) psychically attacks Ash's internal organs, doing such things as damaging his brain's neurons and constricting every muscle and blood vessel in his body.
Using Muei-Tou: Yamikiri, Tsukune Aono (Rosario + Vampire) damages Gyokuro Shuzen's ribs and internal organs.
The effects of Shihoko Kishida's (Darker than Black) ability.
Szayel Aporro Granz (Bleach) can cause internal organ damage to enemies by breaking the organ toys of Voodoo dolls.
Cable (Marvel Comics) blowing Deadpool's brains out with a TK bubble.
Sean Cassidy/Banshee (Marvel Comics) uses his Sonic Scream to give the Blob a massive brain hemorrhage.
Susan Richards (Deadpool Kills the Marvel Universe) creating an invisible bubble inside of Deadpool's head...
...destroying his entire head from the inside.
Hou Ken, the Bushin (Kingdom) sending his inner chi into Shin's abdomen rupturing his organs.
Skarlet (Mortal Kombat 11) rapidly transfuses her blood into an opponent's heart, causing it to explode.
Scar (Fullmetal Alchemist)