Angiographic embolization of seriously bleeding vessels as an emergency procedure after traumatic disruption of the symphysis

Bleeding after instable fractures of the pelvic ring results in a mortality-rate of 7-21 percent. A 65-year-old male patient who fell from his horse and sustained an open book injury with disruption of the symphysis and iliosacral joint developed a dangerous haemorrhagic shock situation in the emergency room. A computer tomography with contrast medium was performed immediately. The outflow of contrast medium behind the symphysis indicated an acute arterial bleeding. An angiography revealed a bleeding from both Aa. obturatoriae and the right A. epigastrica inferior. The difficulty to stop the bleeding surgically resulted in the decision to embolize the vessels angiographically. This procedure terminated the acute bleeding and haemorrhagic shock situation immediately. The pelvic ring disruption was stabilized by internal fixation ten days later. The patient had an uncomplicated course.