Internal pudendal pseudoaneurysm complicating an ischial pressure sore

A 23-year-old paraplegic patient experienced two episodes of substantial hemorrhage from an ischial pressure sore. Computed tomography showed that the wound extended into the pelvis and retroperitoneum, and arteriography demonstrated a pseudoaneurysm of the internal pudendal artery. The artery was selectively embolized, permitting debridement and flap coverage uncomplicated by bleeding. Bleeding from a pelvic extension of a pressure sore can be a catastrophic combination of distorted anatomy and relatively inaccessible vessels. As in hemorrhagic complications of pelvic trauma, tumors, and radiation, arteriography and transcatheter embolization can localize and control the source of bleeding.