title: Massive Rectal Hemorrhage from the Middle Hemorrhoidal Artery after Blunt Perineal Trauma Without Pelvic Fracture.
abstract: BACKGROUND
  Severe pelvic hemorrhage after blunt trauma without bony fracture has been reported occasionally, and clinical presentation as a delayed massive rectal bleeding is very rare.
  
  
  METHODS
  The case of an 86-year-old woman with massive rectal bleeding 12 h after mild blunt perineal trauma is presented. Physical examination revealed an extensive perineal hematoma and a 2-cm laceration in the posterior rectal wall. Pelvic CT scan revealed a large mesorectal hematoma causing extrinsic compression of the rectal lumen. No bony fracture was observed. Selective arteriography was then performed showing hemorrhage resulting from the right middle hemorrhoidal artery, branch of the internal pudendal artery. Transcatheter embolization of coils successfully controlled the bleeding. However, the patient developed a respiratory distress syndrome and renal failure with no response to the treatment and she died 3 days later.
  
  
  CONCLUSIONS
  This report is unique not only for the unusual association of pelvic hemorrhage and rectal injury after blunt trauma without pelvic fracture but also because of the clinical presentation as a massive rectal bleeding. Undoubtedly, the delayed diagnosis and treatment, 12 h after the trauma, contributed to the fatal outcome.
authors.affiliation: Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain. mpera@imas.imim.es.|Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. mpera@imas.imim.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.affiliation: Department of Vascular and Interventional Radiology, CDI, Hospital Clinic, Barcelona, Spain.
authors.forename: Isabel M
authors.initials: IM
authors.lastname: Real
authors.affiliation: Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Pascual
authors.affiliation: Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Isidro
authors.initials: I
authors.lastname: Martinez
authors.affiliation: Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
keywords: Blunt pelvic trauma; Rectal bleeding; Transcatheter embolization