Traumatic presacral hemorrhage: angiographic diagnosis and therapy.

Presacral hemorrhage commonly accompanies fractures of the posterior pelvic ring. The source of this bleeding is the fractured cancellous bone and supporting ligamentous structures of the sacrum and sacroiliac joint. The radiologic appearance is of granular and punctate contrast accumulations due to extravasation from the iliolumbar and lateral sacral branches of the hypogastric artery. This bleeding can be controlled by small particle embolotherapy provided care is taken not to bypass the posterior division of the hypogastric artery.