Massive gluteal muscle necrosis after iliac arterial emboliz
Traumatic pelvic injuries causing retroperitoneal bleeding can be managed with angiographic embolization. This procedure carries a small but potentially devastating risk of gluteal muscle necrosis.

The present case published in Journal of Orthopaedic Case Reports, describes massive gluteal muscle necrosis following angiographic embolization for hemorrhage from pelvic fracture.

An 18-year-old male collegiate bound football lineman was an unrestrained driver in a rollover motor vehicle accident with resulting prolonged extrication and a positive blood alcohol screen. He was intubated at the scene and taken to a Level-1 trauma center. At presentation, he was found to have multiple fractures, including an open book pelvic fracture with complete disruption of the posterior sacroiliac complex resulting in both vertical and rotational instability of the left hemipelvis with associated pubic symphysis diastasis and left greater than right sacroiliac joint disruption.

He sustained a concomitant left open comminuted femoral shaft fracture and a left distal tibia shaft fracture. His systolic blood pressure was in the 80s on admission, he was tachycardic, and the focused assessment with sonography for trauma scan was positive in the pelvic windows. The patient’s pelvis was bound with a sheet and secured using hemostats. Pulses were detected with Doppler ultrasound in the bilateral lower extremities.

Due to poor response to initial fluid bolus and sustained tachycardia, he was taken to the angiography suite where significant slowing of flow within the left superior gluteal and left internal pudendal arteries with radiographic blush was found. This was thought to be due to vasospasm versus distal arterial injury, and empiric Gelfoam embolization of the left internal iliac artery was performed.

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