Arterial haemorrhage is a potentially life threatening
complication in severe pelvic ring injuries such as “open
book” fractures. These injuries mostly implicate the
posterior branches of the internal iliac artery. However, we
report an unusual case wherein the source of bleeding was
identified to be the internal pudendal artery and its branches.
Patient was a 27-year-old male who presented to the
emergency following an alleged history of road traffic
accident and was diagnosed as a case of pelvic fracture
(Young and Burgess Antero-Posterior Compression II) with
sacral fracture (Denis type 2) with suspected urethral injury.
Computerised Tomography (CT) angiogram revealed
contrast extravasation from the right internal pudendal
artery. However, digital subtraction angiography (DSA) was
normal indicating spontaneous closure of the arterial bleeder.
Surgical stabilisation of the fracture was carried out and
subsequently, patient was discharged. This report serves to
highlight that although uncommon, internal pudendal artery
can be injured in hemodynamically unstable “open book”
pelvic fractures and hence, must be always ruled out.