Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?. Issue 1 (21st September 2020)

• Record Type: Journal Article
• Authors: Frigiolini, Francesca; Lo Pinto, Sara; Caputo, Fiorella; Barranco, Rosario; Fraternali Orcioni, Giulio; Bonsignore, Alessandro; Ventura, Francesco
• Is Part Of: Journal of forensic sciences. Volume 66:Issue 1(2021)
• Page Start: 393
• Page End: 397
• Publication Date: 2020-09-21
• Subjects: autopsy -- caput medusae -- ectopic variceal hemorrhage -- forensic pathology -- HCV‐related liver cirrhosis -- portal hypertension; Medical jurisprudence -- Periodicals; Forensic sciences -- Periodicals; Forensic Medicine -- Periodicals; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; 363.2505
• DOI: 10.1111/1556-4029.14571
• Languages: English
• ISSNs: 0022-1198

Abstract

Abstract: Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as "caput medusae." Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.