Percutaneous pelvic embolization has become a useful adjunct in the management of life-threatening hemorrhage from pelvic trauma. However, this approach may be preempted by the need for emergency laparotomy. The surgeon is then confronted with a hemodynamically unstable patient with an expanding hematoma in the face of other life-threatening injuries. Bilateral hypogastric artery ligation has failed in this scenario due to extensive collateralization of the pelvic circulation. We present our experience with intraoperative hypogastric artery embolization used in the management of four patients, and review the available literature on the subject.