Hemorrhagic necrosis of the senile endometrium ("apoplexia uteri"). Relation to superficial hemorrhagic necrosis of the bowel.

Abstract

Abstract The uteri of 379 women over 50 years of age were studied at autopsy; endometrial hemorrhage, with or without necrosis, was found in 19. These postmenopausal patients had no evidence of hormonal abnormalities that could have given rise to a situation analogous to menstruation. Every patient experienced varying degrees of cardiovascular decompensation for variable periods before death; a background of organic or functional cardiac disease was uniformly present. Hemorrhagic enteropathy was noted in six (31.6 per cent) of the subjects displaying the endometrial lesion. The common morphologic features and clinical backgrounds of these entities suggest a similar pathogenetic mechanism: inadequate perfusion of the areas in question appears most likely. The occurrence of vaginal bleeding in an elderly female in shock should suggest endometrial ischemia as a possible cause, and it may serve to warn of the development of hemorrhagic necrosis of the bowel.