Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Fatal hemorrhage from peripheral varicose vein rupture

Guendalina Gentile; Stefano Tambuzzi; Michele Boracchi; Alessandro Del Gobbo; Paolo Bailo; Riccardo Zoia

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Varix of the lower extremities is a common entity that eventually presents fatal outcome. Fatal massive bleeding due to rupture of a peripheral varicose vein is rare. The estimated incidence of these cases is 1/1000 autopsies. The case we present is unique among 26,054 autopsies performed in Milan from 1993 to 2020. It describes the investigations carried out in the suspicion of a non-natural event in an elderly woman. She was found dead at home with a large volume of blood near her feet that drained from the right leg. Pathological examination disclosed that the hemorrhage occurred by the rupture of a venous varix of the lower limb. Cases of fatal hemorrhage from peripheral variceal rupture are insidious and require proper characterization. The bloodstain pattern analysis, careful autopsy dissection by layers to demonstrate the rupture, and histologic examination of the lesion are the essential elements to find out the actual cause of death.


Autopsy, Hemorrhage, Varicose veins


1 Aquila I, Sacco MA, Gratteri S, Di Nunzio C, Ricci P. Sudden death by rupture of a varicose vein: case report and review of literature. Med Leg J. 2017;85(1):47-50. PMid:28112026.

2 Morrow PL, Hardin NJ, Karn CM, Beloin R, McDowell RW. Fatal hemorrhage caused by varicose veins. Am J Forensic Med Pathol. 1994;15(2):100-4. PMid:8074099.

3 Racette S, Sauvageau A. Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. 2005;26(3):294-6. PMid:16121090.

4 Nikolić S, Zivković V. Bloodstain pattern in the form of gushing in a case of fatal exsanguination due to ruptured varicose vein. Med Sci Law. 2011;51(1):61-2. PMid:21595424.

5 Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84. PMid:15723761.

6 Doberentz E, Hagemeier L, Veit C, Madea B. Unattended fatal haemorrhage due to spontaneous peripheral varicose vein rupture--two case reports. Forensic Sci Int. 2011;206(1-3):e12-6. PMid:20655677.

7 Nikolić S, Živković V. Fatal exsanguination due to ruptured vericose vein of the lower leg: case report. Srp Arh Celok Lek. 2011;139(11-12):819-23. PMid:22338484.

8 Ampanozi G, Preiss U, Hatch GM, et al. Fatal lower extremity varicose vein rupture. Leg Med (Tokyo). 2011;13(2):87-90. PMid:21144790.

9 Hejna P, Ublova M, Straka L, Zatopkova L. Unattended fatal haemorrhage associated with spontaneous rupture of peripheral varicosity. Soud Lek. 2012;57(2):18-20. PMid:22724651.

10 Cocker DM, Nyamekye IK. Fatal haemorrhage from varicose veins: is the correct advice being given? J R Soc Med. 2008;101(10):515-6. PMid:18840868.

11 Hejna P. A case of fatal spontaneous varicose vein rupture-an example of incorrect first aid. J Forensic Sci. 2009;54(5):1146-8. PMid:19627413.

12 Byard RW, Gilbert JD. The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins. A 10-year autopsy study. Am J Forensic Med Pathol. 2007;28(4):299-302. PMid:18043015.

13 Byard RW, Veldhoen D, Manock C, Gilbert JD. Blood stain pattern interpretation in cases of fatal haemorrhage from ruptured varicose veins. J Forensic Leg Med. 2007;14(3):155-8. PMid:16730472.

14 Gentile G, Galante N, Tambuzzi S, Zoja R. A forensic analysis on 53 cases of complex suicides and one complicated assessed at the Bureau of Legal Medicine of Milan (Italy). Forensic Sci Int. 2021;319:110662. PMid:33401231.

15 Evans GA, Evans DM, Seal RM, Craven JL. Spontaneous fatal haemorrhage caused by varicose veins. Lancet. 1973;2(7842):1359-61. PMid:4128056.

16 Wigle RL, Anderson GV Jr. Exsanguinating hemorrhage from peripheral varicosities. Ann Emerg Med. 1988;17(1):80-2. PMid:3337422.

17 Cittadini F, Albertacci G, Pascali VL. Unattended fatal hemorrhage caused by spontaneous rupture of a varicose vein. Am J Forensic Med Pathol. 2008;29(1):92. PMid:19749628.

18 Sauvageau A, Schellenberg M, Racette S, Julien F. Bloodstain pattern analysis in a case of fatal varicose vein rupture. Am J Forensic Med Pathol. 2007;28(1):35-7. PMid:17325461.

19 Serinelli S, Bonaccorso L, Gitto L. Fatal bleeding caused by a ruptured varicose vein. Med Leg J. 2020;88(1):41-4. PMid:31928306.

20 Gilbert JD, Byard RW. Ruptured varicose veins and fatal hemorrhage. Forensic Sci Med Pathol. 2018;14(2):244-7. PMid:28695421.

21 Serra R, Ielapi N, Bevacqua E, et al. Haemorrhage from varicose veins and varicose ulceration: a systematic review. Int Wound J. 2018;15(5):829-33. PMid:29808553.

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