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Stable fracture of the pubic rami: a rare cause of life-threatening bleeding from the inferior epigastric artery managed with transcatheter embolization

Published online by Cambridge University Press:  21 May 2015

Romaric Loffroy ,
Jean-Michel Yeguiayan ,
Boris Guiu ,
Jean-Pierre Cercueil  and
Denis Krausé
Romaric Loffroy*
Affiliation:
Department of Diagnostic and Therapeutic Imaging, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France
Jean-Michel Yeguiayan
Affiliation:
Department of Anesthesiology and Intensive Care, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France
Boris Guiu
Affiliation:
Department of Diagnostic and Therapeutic Imaging, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France
Jean-Pierre Cercueil
Affiliation:
Department of Diagnostic and Therapeutic Imaging, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France
Denis Krausé
Affiliation:
Department of Diagnostic and Therapeutic Imaging, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France
*
Department of Diagnostic and Therapeutic Imaging, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon cedex, France; [email protected]

Abstract

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Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had post-traumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization.

Keywords

pelvic fracturehemorrhageCTtranscatheter embolization
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 4 , July 2008 , pp. 392 - 395
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Meyers, TJ, Smith, WR, Ferrari, JD, et al. Avulsion of the pubic branch of the inferior epigastric artery: a cause of hemodynamic instability in minimally displaced fractures of the pubic rami. J Trauma 2000;49:750–3.Google Scholar
2.Wong, TC, Chan, WL, Wu, WC. Life threatening stable pubic rami fracture. Injury Extra. 2005;36:300–2.Google Scholar
3.Mcdonald, DJ, Tollan, CJ, Robertson, I, et al. Massive haemorrhage after a low-energy pubic ramus fracture in a 71-year-old-woman. Postgrad Med J 2006;82:e25.Google Scholar
4.Neidhardt, JPH. Muscles of the abdomen. In: Chevrel, JP, editor. Clinical anatomy — trunk. Paris (FR): Springer; 1996. p. 306–33.Google Scholar
5.Hurd, WW, Pearl, ML, DeLancey, JO, et al. Laparoscopic injury of abdominal wall blood vessels: a report of three cases. Obstet Gynecol 1993;82:673–6.Google Scholar
6.Samandouras, G, Wadley, J, Afshar, F. Life-threatening intra-abdominal haemorrhage following insertion of a lumboperitoneal shunt. Br J Neurosurg 2002;16:192–3.CrossRefGoogle ScholarPubMed
7.Dumortier, J, Poncet, G, Belbouab, S, et al. Severe hemorrhage from the epigastric after ascites paracentesis. Gastroenterol Clin Biol 2002;26:180–1.Google Scholar
8.Miyauchi, T, Ishikawa, M, Miki, H. Rectus sheath hematoma in an elderly woman under anti-coagulant therapy. J Med Invest 2001;48:216–20.Google Scholar
9.Basile, A, Medina, JG, Mundo, E, et al. Transcatheter arterial embolization of concurrent spontaneous hematomas of the rectus sheath and psoas muscle in patients undergoing anticoagulation. Cardiovasc Intervent Radiol 2004;27:659–62.Google Scholar
10.Wilson, CJ, Edwards, R. Massive extraperitoneal hemorrhage after soft tissue trauma to the pubic branch of the inferior epigastric artery. J Trauma 2000;48:779–80.CrossRefGoogle Scholar
11.Baumgartner, F, White, GH, White, RA, et al. Delayed, exsanguinating pelvic hemorrhage after blunt trauma with bony fracture: case report. J Trauma 1990;30:1603–5.Google Scholar
12.Ben-Menachem, Y, Coldwell, DM, Young, JWR, et al. Hemorrhage associated with pelvic fractures: causes, diagnosis and emergent management. AJR Am J Roentgenol 1991;157:1005–14.Google Scholar