Massive fatal rectal hemorrhage from capillary oozing: Case report

Abstract

We have related the unfortunate history of an unrecognized case of gangrenous appendicitis in an individual whose appreciation of pain was remarkably dull. The pus from the appendiceal abscess perforated the parietal peritoneum and travelled upward to the liver. Extending along the right branch of the portal vein the infection produced an enormous liver abscess which later ruptured and drained through the appendiceal incision. Further extension of the infection proceeded by the retroperitoneal route toward the pelvic brim. The mesentery was involved and in one particular area an inflammatory tumor developed. This tumor was adjacent and adherent to the sigmoid. The wall of the sigmoid was edematous and congested at the area of contact. No open lesion of the sigmoid or in fact any portion of the intestinal tract could be demonstrated at autopsy and yet this patient expired as a result of a massive rectal hemorrhage. The remarkable feature of the case is the fact that such a large quantity of blood reached the lumen of the bowel through an intact but congested mucosa. Capillary oozing of this character is frequently noted in the stomach resulting in the so-called coffee-ground vomitus. In our experience such bleeding on an extensive scale is rarely seen in the lower end of the intestinal tract.