Nikolić Slobodan, Živković Vladimir
Srp Arh Celok Lek. 2011 Nov-Dec;139(11-12):819-23. doi: 10.2298/sarh1112819n.
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.
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.
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.
