Perineal bruising: a sinister sign for leaking iliac aneurysms?

Ruptured false iliac aneurysms carry high mortality of up to 57%. It should be suspected whenever a patient who had previous aortic aneurysm repaired presents with bizarre lower abdominal symptoms. In the literature, different presentations have been reported, e.g progressive hydronephrosis, small intestinal obstruction, chronic venous insufficiency, arterio-venous fistula, and gross haematuria from arterio-vesical fistula. We report a patient suffering from a ruptured iliac aneurysm associated with a new sign that has not been described hitherto: perineal bruising.