Saturday, September 5, 2015
Death from a ruptured varicose vein
Lots of people worldwide suffer from varicose veins - twisted, enlarged veins, usually on the legs and ankles. Although this unsightly condition is usually benign, occasionally it can prove life-threatening. Massive hemorrhage caused by vein rupture is an unusual complication of this common venous pathology. Such bleeding demands immediate medical intervention, otherwise the patient can actually bleed to death!
In one slightly gruesome case, a neighbor found a 66-year-old woman dead in her house, surrounded by a large quantity of blood. Multiple bloodsoaked tissues were found around her body, as shown in the photo below, showing that she had frantically tried to stop the bleeding. The examination of the rest of the house revealed smears and smaller blood pools. The lady had lived alone and her medical history was unknown.
Medical mystery? Not quite. Autopsy soon solved the puzzle. It revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein. Signs of pulmonary edema and liver cirrhosis were also discovered. Toxicological analysis was negative.
Death from fatal hemorrhage due to varicose vein rupture is a well-described clinical entity; 23 cases were reported during a single year in England and Wales. The phenomenon was described for the first time in 1973. The youngest person dying of fatal varicose vein rupture has been reported to be a 29-year-old man who was found deceased in his store lying in a pool of blood.
Characteristic features of deaths due to massive bleeding from a ruptured varicose vein include old age, social isolation, underlying medical conditions (e.g. restricted mobility, dementia), hemorrhage related to minor trauma and certain associated features such as alcohol consumption or anticoagulant medications. Another important risk factor is sclerotic changes of the vessel walls that may lead to spontaneous hemorrhage. A coexisting disease, such as ischemic heart disease, also increases the risk of a fatal outcome. Interestingly, in the case described here, the presence of liver cirrhosis seems to have contributed to the lady's death, since a diseased liver has a reduced capacity to produce coagulation factors. The impaired ability of the blood to clot undoubtedly made the bleeding more intense and longer.
Fragkouli K, Mitselou A, Boumba VA, Siozios G, Vougioklakis GT, Vougiouklakis T. (2012) Unusual death due to a bleeding from a varicose vein: a case report. BMC Res Notes 5: 488.