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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.


Source:

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.




1 comment:

  1. It's not quite the same scenario, I know, but still indicative that varicose veins can be fatal ... At the midpoint of my training we admitted a 42yo woman for elective stripping (removal) of the short scaphenous vein in her right leg the following day, which happened to be my day off. When I returned to work & she wasn't there I naturally asked where she was & was informed that she had died on the operating table. Apparently the varicosity was so severe that, during the procedure, a clot broke off & travelled to her heart, almost instantly causing a massive, irreversible, infarct that resulted in death. It had been considered such a minor procedure that her death was shocking & unexpected by all. Whilst speaking to her surgeon later that day, he told me that if she'd had it assessed & treated earlier, the risk of this happening would've been greatly reduced. Some may say that the surgical intervention was a contributing factor in her death but I don't believe that ... surgery, whilst not risk-free nowadays, is common enough that the risk to normal, healthy, people is considered minimal by most members of society & any complications that occur usually result from underlying, pre-existing, conditions. So this is a timely reminder to all to get any anomaly checked as soon as it becomes apparent. Don't leave things to chance or in the hope that it will go away on its own. I've never forgotten that lady & it serves to remind me that I'd rather be embarrassed for worrying about nothing than be dead because my pride may be dented by asking a stupid question - one that could've made all the difference to my life! SO PLEASE TAKE HEED.

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