CT angiography of the lower abdomen should be considered with vaginal trauma and excessive bleeding, even though there are no pelvic fractures present.

A healthy woman in her 20s presented to the emergency department (ED) after she endured a high-energy trauma during a dirt bike race. Physical examination showed no signs of thoracic or abdominal injury. Her pubic bone was painful at palpation, with a large amount of vaginal bleeding and a rupture of the vaginal back wall. Additional imaging with X-rays and extended focused assessment with sonography in trauma showed no fractures or free fluid in the abdomen, and the patient was then taken to the operating room for closure of the rupture. This patient became haemodynamically unstable during the operative procedure because of a transection of a side branch of the left internal iliac artery. Angiography with selective embolisation was performed, after which the bleeding stopped. We present a rare case of a high-pressure arterial bleed in the pelvis due to blunt trauma without osseous injuries. The learning point of this case is that prior to the operative procedure, a CT angiography of the abdomen should have been performed in the ED. Even though traumatic isolated injury to the internal iliac artery is a rare occurrence and the patient was initially haemodynamically stable, the intensity of the trauma and a large amount of vaginal bleeding warranted additional imaging.