DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.051

Pages: 528-531

Renal trauma is usually managed conservatively, but complications may require intervention. The association of urinary extravasation and renal pseudoaneurysm is uncommon. We report a 33-year-old man with an AAST grade IV right renal injury after a road traffic accident. Initial CT showed collecting system injury with urinary extravasation and a 10 × 9 mm pseudoaneurysm of the superior segmental artery. He was treated with resuscitation, blood transfusion, antibiotics, and double-J ureteral stenting, with initial improvement. One month later, he re-presented with gross hematuria and severe anemia (Hb 5 g/dL). CT urography demonstrated a large partially thrombosed hematoma fed by the superior segmental artery and a massive bladder clot. Selective angiography confirmed pseudoaneurysm rupture, and selective arterial embolization achieved complete exclusion, followed by endoscopic clot evacuation. The patient was discharged in stable condition. This case emphasizes the risk of delayed, life-threatening hematuria after high-grade renal trauma and supports early consideration of selective embolization when a post-traumatic pseudoaneurysm is suspected.