Perineal and bladder necrosis following bilateral internal iliac artery ligation. Report of a case

Abdominoperineal resection with pelvic sidewall dissection is not uncommonly performed for treatment of bulky primary or locally recurrent rectal neoplasms. Usually, the internal iliac arteries and veins are ligated bilaterally early in the course of the procedure to reduce intraoperative blood loss and to facilitate subsequent dissection of the pelvic sidewalls. No complications related to bilateral internal iliac artery ligation in this setting have been described previously. In this report, profound vesical and perineal necrosis after bilateral internal iliac artery ligation occurred in a female patient operated on for recurrent rectal cancer. If the internal iliac artery is ligated below the take-off of the gluteal vessels, perineal necrosis can be prevented.