Hongwei Xu Cong He ^*

• Shaoxing Second Hospital, Shaoxing, China

Introduction: Retroperitoneal hematoma with ongoing hemorrhage is a rare but critical condition following blunt abdominal trauma, requiring urgent evaluation and management. This case details a large retroperitoneal hematoma in the right iliac fossa caused by a rupture of the deep circumflex iliac artery (DCIA), successfully treated with transcatheter arterial embolization.A 66-year-old female presented to our hospital six hours after an electric tricycle accident with dizziness, fatigue, hypotension (80/50 mmHg), and tachycardia (105 beats/min).Laboratory tests revealed a hemoglobin level of 9.2 g/dl and a hematocrit level of 27.5%. Contrastenhanced CT showed an 18 cm × 10 cm × 5 cm retroperitoneal hematoma in the right iliac fossa with active bleeding. Emergent angiography identified the bleeding source as a branch of the right DCIA.Embolization was performed using a microcoil through a coaxial microcatheter positioned proximal to the bleeding site, successfully stopping the hemorrhage. The patient's condition stabilized, and ultrasound monitoring showed a gradual reduction in hematoma size. The patient was discharged two weeks later.This case highlights a rare but severe instance of retroperitoneal hematoma due to DCIA rupture, effectively managed with transcatheter arterial embolization. The utility of contrastenhanced CT and angiography in diagnosing active bleeding is emphasized, underscoring the efficacy of transcatheter embolization as a critical intervention in such life-threatening situations.