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June 1996

Perirectal Hematoma Presenting as Purpura

Author Affiliations

Massachusetts General Hospital, Harvard Medical School, Boston

Arch Dermatol. 1996;132(6):615-616. doi:10.1001/archderm.1996.03890300027003

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

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