Srpski arhiv za celokupno lekarstvo 2011 Volume 139, Issue 11-12, Pages: 819-823
https://doi.org/10.2298/SARH1112819N
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Fatal exsanguination due to ruptured vericose vein of the lower leg: Case report
Nikolić Slobodan (Institut za sudsku medicinu, Medicinski fakultet, Beograd)
Živković Vladimir (Institut za sudsku medicinu, Medicinski fakultet, Beograd)
Introduction. Lethal exanguination due to haemorrhage from ruptured
peripheral varicose veins of the lower leg usually in the elderly are
exceptionally rare in clinical, and particularly in forensic medicine. In
persons with varicosities there are two types of lower leg ulcers (acute
perforated and chronic) that can be associated with spontaneous bleeding.
Ulcer exanguination can occur spontaneously or after a minor injury. Injuries
in the ulcer region are rarer. Case Outline. We present a case of fatal
exsanguination due to a ruptured varicose vein in a 77-year-old woman. The
body was found on the porch floor, beside a sink, lying on the back, with
bent knees, so that the lower legs were almost in the standing position, with
the feet in a pool of blood. The entire interior of the house floor was
covered with various bloodstains; blood-drops in form of spilling and
spattering, foot-prints, as well as larger pools of blood. Death was
attributed to massive external haemorrhage due to the acute perforated ulcer
of the right lower leg with the rupture of the varicose vein wall surface
along the entire depth. Conclusion. Although death due to haemorrhage from
ruptured peripheral varicose veins is an uncommon complication of this
disease, it should be taken into consideration by the forensic medicine
examiner. In such cases autopsy should determine both the origin of bleeding
(varicosities and venous wall damage) and other underlying conditions,
primarily ischemic cardiac disease. To resolve such cases, full cooperation
with investigators and police is necessary.
Keywords: varicose veins, exsanguination, autopsy, forensic pathology