Several reports of lumbar artery injuries have been published; however, cases of hypovolemic shock associated with relatively safe procedures like intradiscal electrothermal therapy (IDET) and recurrent bleeding through the communicating artery are rare. The authors present a case of a 71-year-old male who developed a retroperitoneal hemorrhage caused by an L4 lumbar artery injury during IDET, leading to hypovolemic shock. The patient was treated with two embolization procedures.

Ischial bursitis is a relatively common cystic lesion that is palpable as a mass in the buttocks. On the other hand, hemorrhagic ischial bursitis accompanied by vascular injury is uncommon, and it can be challenging to diagnose clinically or radiologically. This paper reports a 74-year-old male patient with a cystic lesion in the right ischial tuberosity that occurred after a fall from a ladder 2 months earlier. The initial diagnosis of ischial bursitis was suggested, but conservative treatment did not lead to improvement. Subsequent follow-up showed that the condition was a hemorrhagic ischial bursitis with vascular damage involving a branch of the internal pudendal artery. The patient experienced improvement after undergoing percutaneous embolization.