Surgical management of presacral bleeding

Area of Science:

• Colorectal Surgery
• Surgical Hemostasis
• Vascular Anatomy

Background:

• Presacral venous bleeding is a rare but life-threatening complication during rectal surgery.
• Dissection outside Waldeyer's fascia can damage presacral venous plexus or sacral basivertebral veins, leading to severe bleeding.
• Conventional hemostatic measures are often insufficient to control this hemorrhage.

Purpose of the Study:

• To systematically review and classify available techniques for managing presacral venous bleeding.
• To provide a comprehensive overview of creative solutions for controlling presacral hemorrhage.
• To address the need for effective management strategies for this surgical complication.

Main Methods:

• Systematic literature search of MEDLINE and Embase databases (1960-2013).
• Inclusion of articles detailing incidence, surgical approach, case numbers, and success rates of presacral venous bleeding.
• Analysis of reported data on presacral bleeding management.

Main Results:

• Creative tamponade solutions have been described to avoid reoperation.
• Few cases of presacral venous bleeding are reported in the literature.
• Alternative methods for definitive bleeding control have been documented.

Conclusions:

• Effective management of presacral venous bleeding often requires alternative techniques beyond conventional hemostasis.
• A practical classification of available management techniques is proposed.
• Further research and reporting on this complication are warranted.