Buttock wounds: beware what lies beneath

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Radiology

Background:

• A 25-year-old male presented with multiple stab wounds, initially managed conservatively with wound closure.
• Initial triple-phase CT angiography showed no acute bleeding.

Observation:

• The patient had seven emergency department re-presentations over one month due to persistent bleeding and wound breakdown.
• Surgical exploration under general anesthesia revealed profuse arterial bleeding and a large, previously undetected pseudoaneurysm.
• The pseudoaneurysm was likely tamponaded by a hematoma, explaining the initial negative CT findings.

Findings:

• A large pseudoaneurysm in the buttock was the source of recurrent arterial bleeding.
• Delayed diagnosis of the pseudoaneurysm occurred despite initial CT angiography.
• Successful surgical intervention and hematoma evacuation led to definitive hemorrhage control.

Implications:

• This case highlights the potential for missed vascular injuries, such as pseudoaneurysms, in trauma patients.
• It underscores the importance of thorough re-evaluation and advanced imaging in cases of persistent post-traumatic bleeding.
• Prompt vascular surgical consultation and intervention are crucial for managing delayed post-traumatic hemorrhage.