title: Management of massive presacral bleeding during low pelvic surgery -- an alternative technique.
abstract: Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. So, effective hemostasis is critical in severe presacral hemorrhage due to the fatal course of this complication. Among the reported methods are packing, thumbtacks, inflatable devices, muscle tamponade, muscle fragment welding and application of endoscopic staplers. Local hemostatic agents in conjunction with other methods such as diathermy, cyanoacrylate tissue adhesives and application of bone wax are among other alternatives which may help to treat this serious complication. The aim of this study is to describe the anatomic and physiologic basis of our mode of treatment, which is new in the literature approach, treating two patients with presacral bleeding during low anterior resection for rectal cancer. The technique is the early clamping of the infrarenal aorta and suture ligation of the bleeding points from the presacral plexus.
authors.affiliation: First Department of Surgery, University of Athens Medical School, Atens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Papalambros
authors.forename: F
authors.initials: F
authors.lastname: Sigala
authors.forename: E
authors.initials: E
authors.lastname: Felekouras
authors.forename: E
authors.initials: E
authors.lastname: Prassas
authors.forename: A
authors.initials: A
authors.lastname: Giannopoulos
authors.forename: A
authors.initials: A
authors.lastname: Aessopos
authors.forename: E
authors.initials: E
authors.lastname: Bastounis
authors.forename: W
authors.initials: W
authors.lastname: Hepp
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery; D004210:Dissection; D005205:Fascia / Q000098:blood supply / Q000293:injuries; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery*; D008297:Male; D010388:Pelvis / Q000601:surgery*; D011479:Protamines / Q000008:administration & dosage; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000098:blood supply / Q000601:surgery; D012447:Sacrum / Q000098:blood supply; D013525:Surgical Instruments; D013536:Suture Techniques; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery
chemical_list: D011479:Protamines