title: Massive haemorrhage from the internal iliac artery following a low energy superior pubic ramus fracture in a 73-year-old man.
abstract: We report a case of a 73-year-old man with a background of aspirin use who fell and sustained a minimally displaced right superior pubic ramus fracture. He subsequently developed hypotension that necessitated fluid resuscitation, associated with a significant drop in blood haemoglobin levels that required a packed red blood cell transfusion. CT scans revealed the presence of two pelvic haematomas, with ongoing bleeding. An angiogram demonstrated bleeding from the superior vesical branch of the anterior division of the right internal iliac artery, which was successfully embolised with gelfoam slurry. The patient recovered uneventfully thereafter. This is a unique case involving an unexpected injury to the superior vesical branch of the anterior division of the internal iliac artery following low energy trauma to an elderly man. We recommend that patients who develop hypotension following a seemingly-benign isolated pubic ramus fracture be evaluated for concomitant arterial injuries with the relevant CT imaging and angiography.
authors.affiliation: Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
authors.forename: James
authors.initials: J
authors.lastname: Wee
authors.affiliation: Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Lua
authors.affiliation: Adj Asst Prof, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
authors.forename: Danny Thomas
authors.initials: DT
authors.lastname: Louange
keywords: Haemorrhage; Hypotension shock; Pubic ramus fracture