Recurrent gluteal haematoma: two internal iliac artery-associated bleeding points

Abstract

Isolated iliac artery aneurysms are extremely rare. Gluteal artery aneurysms are also rare, more commonly affecting the superior gluteal artery in association with penetrating trauma, with those of the inferior gluteal artery usually associated with pelvic fractures. We discuss a diagnostically challenging presentation of recurrent subcutaneous gluteal haematoma due to two separate internal iliac artery-associated bleeding points. A 67-year-old man was referred, from a peripheral hospital, with a right-sided subcutaneous gluteal haematoma. This manifested 28 days following minor non-penetrating, non-fracture-associated trauma. Despite repeat blood transfusions, albeit interspersed with days of haemodynamic stability, and despite exclusion of relevant bleeding sources at endoscopy and two surgical explorations, it was only until contrast CT scanning was requested that both bleeding sources were identified and successfully treated by endovascular coil embolization. This provides an important variant and lesson to supplement current literature and understanding of more diagnostically challenging cases of an extremely rare presentation.

Figure 1:

Contrast CT Scan: (a) Inferior gluteal artery haemorrhage. (b) Second site of haemorrhage at the level of division of the internal iliac artery into its anterior and posterior branches, anterior to the sacroiliac joint.

Figure 2:

Interventional Angiogram: Deployment of seven coils to embolize the inflow and outflow vessels of the inferior gluteal artery pseudoaneurysm.