We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding from the petrosal ICA into the middle ear cavity. The pseudoaneurysm was promptly treated with coil embolization and stenting. The patient continues to be monitored regularly with clinical follow-up, and carotid angiography and temporal bone CT revealed no interval changes at the embolized site 3 years after the procedure.