Massive presacral bleeding during rectal surgery: from anatomy to clinical practice

Area of Science:

• Surgical Oncology
• Vascular Surgery
• Anatomy

Background:

• Massive presacral bleeding can occur during rectal carcinoma surgery.
• Understanding the presacral venous system's anatomy is crucial for managing these complications.

Observation:

• A retrospective review identified four cases of massive presacral bleeding during rectal surgery.
• Bleeding originated from either the presacral venous plexus (n=2) or basivertebral veins (n=2).

Findings:

• Surrounding suture ligation effectively controlled bleeding from the presacral venous plexus.
• Electrocautery via an epiploic appendix (epiploic appendix welding) successfully managed bleeding from basivertebral veins.

Implications:

• These techniques offer viable solutions for managing life-threatening presacral hemorrhage.
• Successful control of bleeding minimizes blood loss and facilitates patient recovery.