Internal Pudendal Artery Injury Following An Open Book Pelvic Fracture: A Case Report

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.