Exsanguinating hemorrhage from peripheral varicosities

A 48-year-old woman presented to the emergency department in cardiovascular collapse after the onset of spontaneous bleeding from a noninflamed, nontraumatized varicose vein of the lower extremity. Despite successful immediate resuscitation she later succumbed to the sequelae of hemorrhagic shock. There was no evidence of coagulopathy or coagulation defect. No cardiovascular disease was found on autopsy. Although not common, spontaneous rupture of peripheral varicosities occurs often enough to be of concern. The pathologic lesions have been classified as acute and chronic, with acute lesions occurring in otherwise normal skin. Exsanguination from this source is not mentioned in standard texts, and only 27 cases have been reported in the literature.