Superior gluteal artery hemorrhage causing gluteal compartment syndrome and sciatic neuropathy following iliac crest biopsy: A case report

Introduction: Iliac crest biopsy is a common procedure used in diagnosing hematological conditions. Although the procedure is generally safe, hemorrhagic complications may arise, especially in patients who are anticoagulated. Case Report: This case report describes a 75-year-old male who developed a large gluteal hematoma and sciatic nerve compression following a biopsy of the right posterior iliac crest and resultant injury to the superior gluteal artery. The patient presented one week after the procedure with severe neuropathic pain in sciatic nerve distribution, resulting in significant functional impairment and immobility. Imaging demonstrated a large intermuscular gluteal hematoma, and the patient subsequently underwent surgical evacuation of the hematoma with ligation of the superior gluteal artery. Conclusion: This case highlights the importance of early recognition and prompt management of this rare complication following iliac crest biopsy. Although anticoagulation is not routinely withheld for this low-risk bleeding procedure, clinicians should maintain a high index of suspicion for significant hemorrhagic complications in anticoagulated patients presenting with severe post-procedural pain, neurological symptoms, or functional decline.