Elhence A, Gahlot N, Gupta A, Garg P
Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India.
Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India.
Malays Orthop J. 2020 Nov;14(3):180-183. doi: 10.5704/MOJ.2011.030.
Arterial haemorrhage is a potentially life threatening complication in severe pelvic ring injuries such as "open book" fractures. These injuries mostly implicate the posterior branches of the internal iliac artery. However, we report an unusual case wherein the source of bleeding was identified to be the internal pudendal artery and its branches. Patient was a 27-year-old male who presented to the emergency following an alleged history of road traffic accident and was diagnosed as a case of pelvic fracture (Young and Burgess Antero-Posterior Compression II) with sacral fracture (Denis type 2) with suspected urethral injury. Computerised Tomography (CT) angiogram revealed contrast extravasation from the right internal pudendal artery. However, digital subtraction angiography (DSA) was normal indicating spontaneous closure of the arterial bleeder. Surgical stabilisation of the fracture was carried out and subsequently, patient was discharged. This report serves to highlight that although uncommon, internal pudendal artery can be injured in hemodynamically unstable "open book" pelvic fractures and hence, must be always ruled out.
动脉出血是严重骨盆环损伤（如“开书样”骨折）中一种潜在的危及生命的并发症。这些损伤大多累及髂内动脉后支。然而，我们报告了一例不寻常的病例，其中出血源被确定为阴部内动脉及其分支。患者为一名27岁男性，据称有道路交通事故史后被送往急诊，被诊断为骨盆骨折（Young和Burgess前后挤压II型）伴骶骨骨折（Denis 2型），怀疑有尿道损伤。计算机断层扫描（CT）血管造影显示右侧阴部内动脉有造影剂外渗。然而，数字减影血管造影（DSA）正常，表明动脉出血已自发停止。对骨折进行了手术固定，随后患者出院。本报告旨在强调，尽管阴部内动脉损伤在血流动力学不稳定的“开书样”骨盆骨折中并不常见，但必须始终予以排除。
