A 68-year-old male with a history of chronic ethanol abuse was found dead in his washroom with blood spattered on his clothing, the floor, and in a small bucket at his feet. At autopsy, he was found to have micronodular cirrhosis and diffuse fatty change of the liver. The blood arose from esophageal varices. He probably intended to use the bucket to throw up in, but ended like this.
As with bleeding peptic ulcers and bronchoarterial fistulas, bleeding esophageal varices can produce a dramatic scene that may initially appear to be suspicious for violence. It will be rapidly evident that the blood originates from the mouth, as opposed to any injury, and the autopsy findings of bleeding esophageal varices associated with micronodular cirrhosis of the liver will confirm this impression.
Fig.1
Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver.
Chronic alcoholics can die suddenly and unexpectedly, with the only significant findings at autopsy being diffuse fatty change of the liver (and occasionally cirrhosis and/or background alcoholic hepatitis) together with toxicologic findings of either no or a nonlethal ethanol level in the blood. These deaths are attributed to chronic ethanol abuse; however, the exact mechanism by which death occurs is still not clearly understood.
People hospitalized with alcohol use disorder have an average life expectancy of 47–53 years (men) and 50–58 years (women) and die 24–28 years earlier than people in the general population.
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