Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases.
BACKGROUND
Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. Traditional attempts at control include tamponade with pelvic packing and application of sacral thumbtacks. The aim of this review is to describe the anatomic basis of injury and summarize our experience with this challenging problem, with emphasis on the simple, readily available, effective technique of rectus abdominis muscle fragment welding.


METHODS
A retrospective review of eight patients who underwent muscle fragment welding for presacral bleeding incurred during rectal mobilization was undertaken. This technique involves harvesting a small piece of rectus abdominis muscle, which is held in place with a forceps to occlude the bleeding site. Electrocautery adjusted to the highest setting is then applied to the forceps to "weld" closed the bleeding point.


RESULTS
Control of presacral bleeding was achieved in all eight patients (3 males) with this technique without complications attributable to this method. Previous attempts at pelvic packing failed in all eight patients.


CONCLUSIONS
Muscle fragment welding is a safe, readily available, and highly effective method of controlling massive presacral bleeding.
Harrison
Jacqueline L
JL
Department of Colorectal Surgery, Cook County Hospital, Chicago, Illinois, USA.
Hooks
Vendie H
VH
Pearl
Russell K
RK
Cheape
John D
JD
Lawrence
Mallory A
MA
Orsay
Charles P
CP
Abcarian
Herand
H
D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D012447:Sacrum / Q000098:blood supply*; D016896:Treatment Outcome