# Life-Threatening Retroperitoneal Hemorrhage Caused by Lower Rib Fractures: A Case Report on Successful Management With Transcatheter Arterial Embolization

## TL;DR

A 77-year-old man with lower rib fractures and shock was successfully treated for retroperitoneal hemorrhage using arterial embolization.

## Contribution

Highlights a rare but critical complication of rib fractures and the effectiveness of transcatheter embolization in managing it.

## Key findings

- Retroperitoneal hemorrhage can occur from lower rib fractures and cause life-threatening shock.
- Transcatheter arterial embolization using n-butyl-2-cyanoacrylate effectively achieved hemostasis.
- Contrast-enhanced CT was crucial for diagnosing active bleeding when sonography was negative.

## Abstract

Rib fractures are commonly associated with pulmonary complications; however, they may occasionally cause retroperitoneal hemorrhage, which is a rare but life-threatening condition. We report the case of a 77-year-old male individual who presented with profound hemorrhagic shock after a fall. Imaging revealed fractures of the right 11th and 12th ribs with associated retroperitoneal hemorrhage. Despite a negative focused assessment with sonography for trauma, contrast-enhanced computed tomography revealed active vascular extravasation, necessitating emergency transcatheter arterial embolization. Hemostasis was achieved using n-butyl-2-cyanoacrylate, resulting in rapid stabilization and recovery. This case underscores the importance of considering retroperitoneal hemorrhage in patients with lower rib fractures and shock, particularly when the focused assessment with sonography for trauma findings is negative. This study also highlights the role of contrast-enhanced computed tomography and transcatheter arterial embolization in diagnosis and management, demonstrating the need for a multidisciplinary approach to trauma care.