Introduction: Anemia presented among hospitalized patients is commonly due to gastrointestinal bleeding, but can also be due to chronic diseases or nutritional deficiencies. Evaluation typically includes laboratory studies and endoscopic assessment to localize and identify the bleeding source. If the usual causes are ruled out, vascular causes should be investigated depending on the history and presentation. Pseudoaneurysms are a rare but critical source of internal hemorrhage, often caused by recent surgeries. Early recognition and intervention are essential. We introduce a case which describes a rare pseudoaneurysm in a postoperative patient who was successfully managed through endovascular coil embolization. Description: A 59-year-old female with hypertension, hyperlipidemia, and recent right hip arthroplasty presented with symptomatic anemia (Hgb 6.1 g/dL). A positive fecal occult blood test (FOBT) and an esophagogastroduodenoscopy (EGD) revealed no gastrointestinal bleeding. Persistent anemia despite transfusion raised concern for another bleeding source. Computed tomography (CT) abdomen and pelvis with contrast revealed a 10.8 x 10.0 x 6.2 cm pelvic hematoma. Angiography confirmed a right superior gluteal artery pseudoaneurysm with active bleeding. Intervention Radiology (IR) performed coil embolization and successfully stopped the bleeding, with post-procedural hemoglobin stabilization in the mid-7 g/dL range after an additional one unit of packed red blood cells (pRBC). No further bleeding was identified on follow-up imaging, and the patient remained hemodynamically stable. Discussion: This case highlights the need to consider vascular complications, such as pseudoaneurysm, in postoperative patients with ongoing anemia. While more common causes were initially excluded, continued investigation to identify the source of bleeding was essential. Coil embolization successfully terminated the arterial bleed with minimal invasiveness, reducing the risk of re-bleeding and eliminating the need for open surgical exploration. Imaging and endovascular embolization led to rapid control of the bleeding and clinical improvement. Recognizing these uncommon postoperative complications and the key cooperation with IR is vital for timely and effective management.
ZHONG et al. (Sun,) studied this question.