Penetrating gluteal trauma managed by surgical treatment with an added value of digital subtraction angiography

Penetrating traumas to the gluteal region can occur via vascular injury, nerve injuries, or damage to the perineal organs. Vascular injuries are usually life-threatening injuries in gluteal penetrating traumas. Therefore, the use of angiograms may be necessary for the management of penetrating traumas to assess the bleeding focus. Herein, the case of a 24-year-old male who applied to the emergency department with a penetrating stab wound injury to the gluteal region is presented. Digital subtraction angiography (DSA) was performed for urgent vascular evaluation, which showed a pulsatile bleeding from the femoral left circumflex lateral artery, whereupon the vascular surgeon proximally ligated the type 3 lateral circumflex artery. However, the control DSA taken due to continued bleeding after the procedure revealed that the flow of the ligated lateral circumflex artery was interrupted, but the bleeding continued in the same region with the blood supply of the collateral coming from the iliolumbar branch of the internal iliac artery. Thereupon, a peripheral 5¥60 mm balloon was inflated in the internal iliac artery, and whether the bleeding stopped was evaluated. Afterward, the patient was taken back to surgery by the vascular surgeon, and the bleeding was stopped by collateral ligation. In this case, we showed with a demonstrative case that vascular imaging may be required not only before but also after the procedure in vascular injuries due to penetrating trauma and that treatment can be provided by closure of the feeding artery in both directions in dense collateral areas.