Purple bowel misdiagnosed as intestinal hemorrhage

Abstract

When blood-like discoloration is found during the autopsy, forensic pathologists consider a traumatic origin. This paper presents a case of blood-like discoloration of the bowel arising from a natural cause. Intestinal discoloration by beetroot is a postmortem phenomenon explained by the passive diffusion of the pigment from the lumen of the intestine through the autolyzed intestinal mucosa 1. The pigment is not permanent and can transfer from the intestinal wall to surrounding tissues. Moreover, the color vanished during fixation in buffered formalin and could not be detected on histological examination. We conclude that the purple bowel is rarely reported because preprocedural fasting makes it hard to spot the discoloration in living patients, and the amount of beetroot needed to induce the discoloration is not known. In addition, adequate time must pass between death and autopsy for the passive diffusion to occur 2. Finally, it might be mistaken for hemorrhage due to its similarity in appearance.

Keywords: Beetroot; Betanin; Intestinal hemorrhage; Purple bowel.