Fatal hemoperitoneum due to rupture of retroperitoneal varices

A 47-year-old woman was found her sitting on the street. She was a heavy drinker. She went into cardiopulmonary arrest during emergency transport and died in the hospital approximately 45 minutes after being found. Post-mortem computed tomography (CT) scan showed massive intra-abdominal fluid retention. At autopsy, 2,825 mL of blood was found in the intra-abdominal cavity. The liver showed cirrhosis. The source of bleeding was identified as a ruptured varices in the retroperitoneum at the colo–hepatic curvature. Varices may develop as a result of portal hypertension due to cirrhosis, but they generally occur at the gastroesophageal junction. Varices that develop in other locations are referred to as ectopic varices. And among these, retroperitoneal varices are rare. In the present case, the presence of intra-abdominal hemorrhage could be suspected before autopsy based on post-mortem CT findings, but autopsy was necessary to identify the bleeding source. In conclusion, in cases of intra-abdominal hemorrhage in patients with cirrhosis, ectopic variceal rupture should also be considered. • We have experienced an autopsy case of ruptured retroperitoneal varices. • In the present case, the presence of intra-abdominal hemorrhage could be suspected before autopsy based on symptoms and post-mortem CT findings, but autopsy was necessary to identify the varices as the bleeding source. • In cases of intra-abdominal hemorrhage due to cirrhosis, the possibility of rupture of ectopic varices should be considered and identifying the bleeding source is essential for determining the cause of death.