Presacral venous bleeding during mobilization in rectal cancer.
OBJECTIVE
To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.


METHODS
A review of the databases MEDLINE®and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.


RESULTS
This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.


CONCLUSIONS
A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Jose Enrique
JE
Casal Núñez
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Vincenzo
V
Vigorita
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Alejandro
A
Ruano Poblador
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Ana María
AM
Gay Fernández
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Maria Ángeles
MÁ
Toscano Novella
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Nieves
N
Cáceres Alvarado
Jose Enrique Casal Núñez, Vincenzo Vigorita, Alejandro Ruano Poblador, Ana María Gay Fernández, Maria Ángeles Toscano Novella, Nieves Cáceres Alvarado, Lucinda Pérez Dominguez, Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, 36212 Vigo, Spain.
Lucinda
L
Pérez Dominguez
D016063:Blood Loss, Surgical; D003657:Decision Making; D004564:Electrocoagulation; D006487:Hemostasis; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D057446:Hydrodynamics; D008670:Metals; D010388:Pelvis; D019736:Prostheses and Implants; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012447:Sacrum / Q000033:anatomy & histology / Q000601:surgery; D014680:Veins
D008670:Metals
Pelvic surgery; Presacral hemorrhaging; Rectal surgery; Sacral anatomy; Sacral venous plexus