Purpura may be an important cutaneous sign of intra-abdominal or intrapelvic hemorrhage. Perianal purpura in this patient was a cutaneous sign of a ruptured iliac artery aneurysm.
REPORT OF A CASE
An 85-year-old man presented with a history of sudden onset of intense rectal pain accompanied by suprapubic pain, tenesmus, and difficulty with urination. He was lying down after a large breakfast when he suffered 10 to 15 seconds of exquisite perirectal pain. He denied melena, hematochezia, fever, nausea, vomiting, epistaxis, or other systemic complaints. He had a history of severe peripheral arteriosclerotic vascular disease requiring several repair grafts for an aortic aneurysm, bilateral iliac aneurysms, and bilateral popliteal aneurysms. He underwent a nephrectomy secondary to surgical complications and also suffered from chronic renal insufficiency.On physical examination, his temperature was 100°C; heart rate, 100 beats per minute; and blood pressure, 148/70 mm Hg. His abdomen was supple with audible
Kane KS, Quirk DM, MacLean J, Mackool BT. Perirectal Hematoma Presenting as Purpura. Arch Dermatol. 1996;132(6):615-616. doi:10.1001/archderm.1996.03890300027003