Management of presacral bleeding during rectal resection

Severe presacral bleeding is a troublesome and potentially life-threatening complication during low anterior or abdominoperineal resection. We believe that suturing or cauterization should not be used since this will perpetuate the problem of bleeding in most instances. We recommend the use of hemostatic agents plus laparotomy sponges for compression to control the bleeding. If this fails, then the metallic thumbtack can be used as described herein. It is simple and effective.