Entering the keep, Kain progressed through to an underground 'sewer' style area where he was able to collect the Blood Gout item card and test it usage as a projectile on prisoners and enemies beyond his normal range before returning outside to the swamp.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The external appearance of the Blood Gout Dungeon consisted of a rectangular partially ruined rampart in the southeast of the western Termogent Forest area. The design of the building was reminiscent of the other buildings in the western Termogent Forest, such as the Control Mind Dungeon and the Flame Sword Dungeon, consisting of a dark grey ramparted building complete with crenelation and a flat roof, evocative of a medieval castle-like structure. The building was heavily eroded, worn and ruined, with a gaping hole in the front wall and a tree blocking the doorway on the ground level. An arrowslit was visible partway up the front wall and damage was also visible in several spots on the roof and crenelation.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The internal area of the keep shared many design features with the other keeps of the western Termogent Forest, with distinctive maroon colored brickwork, marbled red doorways and weapons hanging from the walls - although much of the Blood Gout keep also bore a resemblance to other 'sewer' areas, with a pale green and yellow trimmed color scheme, wooden supports and pillars, brown doorways and murkywater.[Blood Omen][Blood Omen/6][Blood Omen strategy guide] The keep was divided into four map areas:
The first map area started in a small square room with a mural of the Blood Gout spell in the center and an inactive teleporter pad along with a Knife fighter. Two doorways were present in the room, with the eastern doorway leading to a larger room containing a save altar. The northern doorway was initially locked but could be opened by using a wall button disguised as a chain in the northeast of the room. The corridor beyond briefly shifted west before heading northward, turning to the right passing a single Blue peasant swordsman before heading southward down a wooden staircase to the next area.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The next area changed into a 'sewer'-style location, with Kain emerging into a wide '+' shaped room with a wide single north-south corridor, bordered by murky water and a pair of captives at the eastern and western ends of the cross. At the center of the cross was laid the Blood Gout spell card and using the spell to drain both captives without crossing the water (or otherwise disposing of them) would cause the southern door to open, allowing Kain to progress to the next area.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The third map area was a large single room with many subdivisions and Spike pits, dividing smaller areas. The entry door was positioned in the northeast of the area, leading to a balcony that ran along the north wall which contained three sets of timed spikes and Red man at arms as hazards. A staircase led down to the south while the balcony continued along to an alcove in the northwest where a captive was chained behind a spike pit along with an anti-toxin artifact and protected by a jelly, requiring Kain to use his newly gained Blood Gout spell to feed and risk being poisoned by the green blood of the jelly - although alternatives such as Wolf Form were also effective in many of these situations. The staircase led down to an open area at the middle of the room with a Red man-at-arms protecting an orange magic sphere. Spike pits were positioned to the south and west, with another prisoner and jelly combination on a platform behind the western pit. Following the path southward between the pits in the southwest corner led down to a narrow path blocked by timed spikes set between two overlooking balconies on the east and west crossing the spikes led to a narrow corridor in the south of the room protected by a Purple slime, with staircases in the east and west which led up to the aforementioned balconies. The western balcony was protected by an Expert knife thrower and contained an anti-toxin and a spike pit The eastern balcony meanwhile contained a Purple slime and another spike pit/prisoner/jelly dilemma. Progressing through the door to the east led to another room with a spike pit protecting a prisoner in the north, while a purple slime and a jelly protected the wide corridor lading south to the exit door and the next area.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The fourth map area began in a wide corridor that turned to the east along with a patrolling jelly, before turning to the north and heading into a set of spikes. Beyond the spikes a Red skeleton patrolled a green magic sphere and a captive suspended in a doorway, and using a projectile attack such as Energy Bolt to blast the skeleton (avoiding the use of Blood gout because of the black-blooded enemies) would drop the spikes, allowing Kain to progress further north along the corridor. The corridor soon reached a deep inverted 'T'-shaped pit filled with murky water. A 'U' shaped platform could be seen in the north patrolled by a red skeleton and using a projectile to blast the skeleton lowered a bridge crossing the pit to the platform which held an Energy bank and an anti toxin at its ends. Reaching the platform and turning to the east, another projectile could be used to blast the Lich on the other side of the pit which dropped another bridge heading east across to the platform on the eastern wall of the room. A Red skeleton patrolled the eastern platform along with an orange magic sphere and an anti-toxin. Following the platform south led west along the southern wall to a Flay artifact and a Blood vial, while to the north the path led through a wide doorway into the next room. The next room was an open rectangular room patrolled by a red skeleton with a stone block supporting an overhead beam in the center and a patch of murky water in the northwest of the room. A projectile firing Lich was positioned atop a square balcony in the southwest, with an Expert knife thrower doing the same from a wide balcony spanning the north of the room. A staircase was positioned in to the northeast of the room - protected by two Shooters on opposite sides of the room - which allowed Kain to reach the northern balcony, where two jellies and two Green jellies along with the knife thrower and a Rune triangle. A strip of spikes with the center prongs lowered protected the doorway leading west into the next room, where a red skeleton, jelly and green magic sphere waited in the small square area beyond. A staircase in the south led down to a wide corridor along the south of the area containing a red skeleton and a Flay artifact, with a staircase just before the end leading up to a platform overlooking the flooded north of the area and protected by two shooters on opposite sides of the room. Collecting the flay opened a bridge leading from the platform across the water to another platform to the north patrolled by a red skeleton. The teleporter pad here was active and allowed Kain to return to the pad in the first map area.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The western area of the Termogent Forest containing the Flame Sword Dungeon , Control Mind Dungeon and Blood Gout Dungeon is labelled in files as "Map 0001 Sect 43" and shares the same "Map 0001" designation as the rest of the overland areas of the game, including the eastern Termogent Frost containing Vorador's Mansion which is labelled as "Map 0001 Sect 44". The internal areas of the keep all share the "Map 0026" designation, with "Sect 00" referring to the opening area with the save altar, "Sect 01" referring to the '+' shaped room containing the Blood Gout spell card, "Sect 02" referring to the room filled with Spike pits, and "Sect 03" referring to the final room with balconies overlooking sewer water. The Developers' level select uses the label "GOUT" for the keep under the "OL5" designation, grouping it with the other buildings in the Termogent Forest. The main "OL" doorway under "OL5" also leads to western forest area.[Blood Omen][5]
The Blood Gout Dungeon has several interesting alternatives to puzzles. Many of the puzzles in the Blood Gout Dungeon revolve around using Blood gout to reach and feed on chained humans that are out of reach beyond Spike pits, Water or similar hazards -however Blood Gout is not necessarily the only way to reach them and many of the hazards could be crossed using alternatives like Wolf Form. In addition the balconies in the east and west of the third chamber can both be accessed using projectiles from the north, preventing damage from the knife thrower as you walk below and hitting the prisoner from the back to take away the risk of hitting the jelly.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]
The official guide Blood Omen: Legacy of Kain—Official Game Secrets features several small references to what are presumably beta or early developmental versions of Blood Omen in its sections on the Blood Gout Dungeon. The guide repeatedly advises using Mist Form to cross Spike pits and thus save Magic energy compared to using Blood Gout, however in the retail version of the game mist cannot be used to cross spike pits, only water. It also mentions using Mist to reach a Blood beaker on the east balcony, positioned on a platform to the north beyond the spike pit. The platform is empty and inaccessible in the retail version of the game.[Blood Omen][Blood Omen/6][Blood Omen strategy guide]