Fatal Haemorrhage from a Varicose Vein: A Case Report from 50 Years Ago
Article Outline
A 55-year old woman died of haemorrhage from a superficial varicose vein on her right leg. She had been in good health and had never been hospitalised. The author discusses the circumstances leading to this tragic event, which happened 50 years ago, and could have been avoided with simple measures. In fact, the actions taken by her relatives before they called for a doctor probably contributed to her death. A brief review of the literature describing such cases is included.
Keywords: Varicose veins, Fatal haemorrhage
Introduction
Few previous reports of fatal haemorrhage from varicose veins have been published.1, 2, 3, 4, 5 In a further report6 the patient was hospitalised and her life was saved with simple measures. The scarcity of case reports of fatal varicose vein haemorrhages could be due to under-reporting, but it is probably an infrequent event.
Case Report
The author is now retired, after 44 years service as physician, the last 41 years as a radiologist. The event dates back to 1957, but it made such an impression on this young doctor that 50 years later, every detail can be recalled.
During my compulsory service as an assistant to a local district medical officer in January 1957, I was on duty and received a late night telephone call from a person living some distance away. He rang on behalf of a neighbour in whose house a woman was ill, because of bleeding from an unspecified source and she needed urgent medical attention. It took three quarters of an hour to reach the patient, partly because of bad winter weather conditions with deep snow in which I had to walk the last half kilometre. In the entrance of the house I noticed in passing two or three buckets with some thin dark red contents. Inside I was received by an elderly couple who were in despair, but calm. They showed me to the next room where a middle-aged woman, sat on a splinter chair. She was pale, unconscious, and cold, without any pulse or respiration, with no sign of life. Rigor mortis was also present so she must have died one or two hours previously. On closer examination she had a tourniquet below her right knee, which was not very tight, and below that a thick bandage consisting of several layers of towels, all stained with blood. Removing them I found a leg ulcer with an open varicosity from where some drops of blood emerged. She was beyond help.
On questioning the couple who were very sorrowful at their loss, I established that the deceased was 55 years old, the younger sister of the housewife, this couple being in their early sixties. The couple had no children. The deceased had been living with them for more than thirty years, as a member of the family. She had been in good health and although she had varicosities on both legs, but never complained about them. They also knew that she had suffered from a leg ulcer, but did not want to seek medical help. During the last two days she had mostly stayed in her own room, but they had noticed that she wore some towels around her leg which looked blood-stained. Earlier in evening they had heard a kind of yawning from her room, and on entering they found her sitting on a chair, very pale, complaining of dizziness and a tendency to faint. She denied having any pain. Around her right leg she had several blood-stained towels. The husband had placed an improvised tourniquet around the calf above the bleeding point, but this had no effect on the bleeding. The patient complained of weakness and said she was going to faint. Instead of laying her down, they supported her in the upright position on the chair. She became unconscious before they decided to call for a doctor. Before doing so, they felt that they should clean the room, removed blood from the floor. They had no telephone so had to contact a neighbour to make a call - unfortunately all too late.
The following is also a part of this tragic story: It was the custom in this district at that time that the local sheriff issued a preliminary death certificate which then was sent to the local physician for completion. On this certificate which came to our office two days later, the sheriff who was an experienced police officer, in the column for cause of death had written “Brain bleeding?”
Discussion and Conclusion
In the previous reports of fatal varicose vein bleeding, there was mild trauma in one, a blow from a fall which contributed to the fatal outcome.1 In another report2 the bleeding was spontaneous, while in the third, fourth and fifth articles three patients,3 one4 and two5 respectively are reported, all of whom succumbed by haemorrhage from varicose veins. In the last article6 one patient is reported who survived thanks to hospitalisation.
As to the present case the reader perhaps asks how a tragedy like this could happen. To understand this one has to consider several facts: The event took place in a remote rural district of the country 50 years ago and few houses had telephones. This was a district with much poverty, the people making their living by a combination of smallholding and sea fishing. It was a small community where all neighbours knew each other well, and helped each other when that was needed. The couple who lost their nearest relative, were also poor, hard-working and honest people who were highly respected by their neighbours. But, their educational level was not high. The husband had heard about tourniquet use. However, in this case it most likely made things worse, because of the way it was applied, above the bleeding point, too loose to stop the arterial supply, but tight enough to partly obstruct the venous return. One may ask oneself if it perhaps had been better for the patient if she had been alone, and had fallen off the chair when she fainted. Lying on the floor, the venous bleeding probably would have stopped by itself. She was supported in the upright position permitting continued haemorrhage and the family waited unnecessarily long before a doctor was called. The cause of death was not established with certainty since no autopsy was performed, but taking into account the history and clinical findings there is little room for doubt.
It is much less likely that this sequence of events would have happened recently. Better communications, good emergency services, improved medical treatment and knowledge of simple first aid measures which have been achieved in the last 50 years now make this a rare event.
References
- . Case of death due to hemorrhage from varicosed veins of the lower extremity following mild trauma (Article in Russian). Sud Med Ekspert. 1969;12(4):49–50
- . Spontaneous fatal haemorrhage caused by varicose veins. Lancet. 1973;15(2):1359–1361
- . Fatal hemorrhage caused by varicose veins. Am J Forensic Med Pathol. 1994;15(2):100–104
- . Fatal hemorrhage from a leg ulcer by varicose veins. Morphol Igazsagugyi Orv Sc. 1983;23(1):61–62
- . Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. 2005;26(3):294–296
- . Bleeding from varicose vein – still potentially fatal: a case report. S Afr Med J. 1985;67(8):303
PII: S1533-3167(07)00003-9
doi:10.1016/j.ejvsextra.2007.02.001
© 2007 Elsevier Ltd. All rights reserved.
Refers to article:
- Fatal Haemorrhage from a Varicose Vein: A Case Report from 50 Years Ago , 20 March 2007
