A Case of Median Sacral Artery Bleeding Stopped by Direct Surgical Ligation

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 30; no. 4; pp. 587 - 590
• Main Authors: Shichijyo, Yuji, Nishiyama, Ryo, Hanari, Naoyuki, Watanabe, Yoshiji, Natsume, Toshiyuki, Maruyama, Takashi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.05.2010; 日本腹部救急医学会
• Subjects: TAE; 正中仙骨動脈出血; 開腹止血術; 骨盤骨折
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.30.587

Transcatheter arterial embolization (TAE) of the bilateral internal iliac arteries is advantageous in controlling retroperitoneal massive hemorrhage associated with pelvic fractures. However, it has recently been reported that TAE of only the bilateral internal iliac arteries occasionally fails to stabilize a patient's hemodynamics. We report the case of a 70-year-old male with pelvic hemorrhage from an irregular sacral artery that was controlled by direct surgical ligation. He was admitted to our hospital following a road accident and was diagnosed as having thoracic abdominal, and sacral injuries. His anemia continued to worsen and hence a CT scan was performed the next day which suggested abdominal hemorrhage. Emergency angiography was performed and it revealed bleeding from the bilateral sacral, left iliopsoas, and median sacral arteries. Bleeding from the bilateral sacral and left iliopsoas arteries was successfully stopped with TAE. However, since the median sacral artery branches from the fifth lumbar artery, it was beyond the reach of the catheter. Therefore, an emergency laparotomy was performed and the injury in the artery was exposed and manually ligated. Hemostasis was obtained and the patient's recovery was excellent. Open surgical hemostasis should be considered in patients with severe pelvic fracture in whom bleeding cannot be controlled with TAE.