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Skin is the first line of defense and encounters a variety of microbes. Some pathogenic strains are often the cause of a broad range of infections of the skin and other body systems. These conditions can affect people of all ages and may have different causes, including genetic factors, infections, autoimmune reactions, environmental factors, and lifestyle choices.
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Buttock wounds: beware what lies beneath.

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A stab wound patient experienced recurrent bleeding due to a missed pseudoaneurysm, requiring surgical intervention for definitive control and successful wound healing.

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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.