Control of presacral venous bleeding during rectal surgery.
BACKGROUND
Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis.


METHODS
From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer, ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix (FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA).


RESULTS
Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss was minimal and drain was removed on day 4 in all 3 patients.


CONCLUSIONS
The use of synthetic hemostatic agents is an effective and simple way to arrest presacral bleeding where conventional methods fail.
Germanos
Stylianos
S
Patision General Hospital, Athens, Greece. Stylianos.germanos@yahoo.co.uk
Bolanis
Ioannis
I
Saedon
Mahmud
M
Baratsis
Sotirios
S
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D003094:Collagen / Q000008:administration & dosage; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D014680:Veins / Q000293:injuries*
C411004:FloSeal Matrix; D006490:Hemostatics; D003094:Collagen