Isolated internal iliac artery infected pseudoaneurysm occlusion using endovascular coil embolisation

A 34-year-old man presented with painful swelling in the right gluteal region. The MRI showed right sacroiliitis and adjacent intramuscular abscess. The abscess was drained by a pigtail insertion followed by incision and drainage. The patient developed persistent bleeding from the drainage site. CT angiogram revealed a large pear-shaped pseudoaneurysm arising from the anterior branch of the right internal iliac artery. The patient had Abrus precatorius poisoning previously resulting in methicillin-resistant Staphylococcus aureus septicaemia, which incited above events. Digital subtraction angiography with coil embolisation of the right internal iliac artery was done under the cover of culture-specific antibiotics along with thorough wound debridement following which the patient's condition improved. Isolated infected pseudoaneurysms of internal iliac arteries, although rare, should be considered in cases of complicated sacroiliitis. Under antibiotic cover, endovascular coil embolisation can be considered as a treatment strategy to treat complicated infected pseudoaneurysms located in difficult anatomical locations.