Abstract
A 74-year-old male was urgently transported to our Emergency Department (ED) because of massive bleeding in his perineal area. He had lost his balance and fell while standing on a chair of approximately 50 cm in height on the scene. A laceration in the perineal area of approximately 3 cm in width was identified and the paramedics applied pressure using gauze to reduce the heavy bleeding. On arriving at ED, he was alert and hemodynamically stable. Urethral catheter was inserted in the perineal wound directly, and pressed manually to control bleeding. Enhanced CT showed leakage of the contrast medium into the perineal tissues. Emergency angiography showed extravasation from the right internal pudendal artery, which was embolized using gelatin sponge. Retrograde cystography showed leakage from the urinary bladder as an extraperitoneal bladder injuly, so suprapubic drainage was constructed, and indwelling urethral catheter was inserted. Twenty-nine days later, the urethral catheter was removed and he was able to urinate on his own. He was discharged after one month hospitalization without any sequelae. Our minimum invasive strategy to control bleeding in a short time was more effective than a surgical approach in the pelvic cavity.
