[Severe retrosacral hemorrhage without bone injury following defenestration]. / Hémorragie grave rétrosacrée sans lésion osseuse associée après défenestration.

ABSTRACT

We describe the case of original haemorrhagic shock after a 22-year-old woman suicidal jumping. The first radiological evaluation showed only a non-bleeding fracture of the first lumbar vertebra (CT-scan) and a calcaneum fracture. Pelvic ring was normal. The exploration of the abdominal system (sonographic evaluation) did not highlight any abnormality. There was no sign of haemodynamic shock and the biological results were normal. Nevertheless, three hours later, severe haemorrhagic shock appeared without organic explanation. After new research (thoracic and abdominal-pelvic CT-scan), the source of bleeding was found in the gluteal muscles without associated pelvic ring fracture. Several vascular haemorrhagic failures were found on little arteries related to the internal iliac left artery. Haemorrhagic loss was important. Radiological gluteal arteries embolisation could have been realized but finally not chosen. The haemorrhage stopped spontaneously after about 36 hours. The early diagnosis was difficult because of the vertebral fracture that constrained strict dorsal position. We could not see the important haematoma without moving the patient. We have not found any description of a severe haemorrhagic shock secondary to a single blunt gluteal muscle.