PMC6351351_01
(a) Initial contrast-enhanced axial computed tomography image showing the perirectal hematoma with extravasated blood (arrow); (b) Initial contrast-enhanced coronal image showing the perirectal hematoma with hemoperitoneum; (c) Initial contrast-enhanced axial computed tomography image showing the pseudoaneurysm (arrow).
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Computed tomography (CT) revealed a hematoma (12 x 10 x 15 cm) with active bleeding in the pelvic cavity and a pseudoaneurysm in the anterior wall of the rectum (Fig. 1).
Operative findings after evacuation of the subperitoneal perirectal hematoma.
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After evacuation of the hematoma and blood, oozing continued in the rectovesical pouch (Fig. 2).
Follow-up contrast-enhanced coronal computed tomography image showing the residual pseudoaneurysm in the rectum (arrow).
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Although the postoperative course was uneventful and there was no evidence of recurrent bleeding on the follow-up CT on the 7th postoperative day (POD), a focal enhancing lesion in the anterior wall of the rectum indicating a residual pseudoaneurysm was noted (Fig. 3).
Follow-up contrast-enhanced axial computed tomography image showing the massive hematoma in the perirectal space, without any definite signs of extravasation.
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On the 11th day POD, his hemoglobin decreased from 11.6 g/dL to 7.9 g/dL, and the follow-up CT revealed recurrent hematoma (6.0 x 4.2 cm) in the pelvic cavity and the residual pseudoaneurysm (Fig. 4).
Arteriogram of the pelvis including both the internal iliac arteries, without any definite signs of extravasation.
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Thus, prophylactic gelfoam embolization at the anterior branch of both the internal iliac arteries was performed (Fig. 5).