Leaking left hypogastric artery aneurysm causing bilateral ureteric obstruction

A pelvic hematoma arising from a leaking left hypogastric aneurysm resulted in the acute onset of bilateral flank pain and bilateral ureteral obstruction in a sixty-four-year-old black man. Intravenous pyelogram revealed a pelvic hematoma with narrowing of both lower ureters, hydroureteronephrosis, and anterior bladder displacement. Cystoscopy revealed anterior displacement of the bladder base which appeared pulsatile. Arteriography confirmed the leaking hypogastric aneurysm, and successful surgical ligation was performed.