Blood-borne metastases are commonly found in the liver, lungs, and bones primarily, but also in the serosal membrane of the peritoneal cavity, the brain, and other locations. Recall that blood drainage from the inferior and middle rectal veins is to the internal iliac veins and the inferior vena cava, and drainage from the superior rectal vein is through the inferior mesenteric vein and the portal system. A twenty-six year old male presents to the E.R. after a motorcycle vs. car accident. The patient is awake and alert, and reports pain in his abdomen and pelvis. Examination also reveals abrasions on his abdominal wall surface and no signs or presence of blood on his external urethral meatus .
Palpation reveals generalized tenderness over the entire abdominal region.
In addition, the patient shows particular discomfort when you attempt to assess the stability of his pelvis by placing your hands over his pubic symphysis and laterally applying pressure over the iliac blades. He does not have full hip extension and rotation when you assess his mobility while laying on the exam table. Rectal exam is negative for gross blood, and the patient has a normally placed prostate. A diagnostic supraumbilical peritoneal lavage turns out negative. You suspect internal bleeding due to the abdominal pain, so you order an angiogram to locate the source.