How I do itControl of presacral venous bleeding during rectal surgery
Section snippets
Patients and Method
A retrospective review of 83 patients who underwent rectal surgery from September 2007 to March 2009 was performed. All the patients who sustained intraoperative presacral bleeding during mobilization of the rectum and methods of hemostasis were noted. Fifty-eight patients had a low anterior resection for rectal cancer and 25 patients had proctocolectomy and ileal anal pouch anastomosis for ulcerative colitis or familial adenomatous polyposis. Three patients (3.6%) with a previous ileorectal
Results
In the first patient, initially we tried to arrest bleeding by cauterization, which exacerbated the bleeding. As an alternative, the pelvis was packed with swabs which resulted in recurrent bleeding as soon as they were removed. Following this, we tried to insert a metallic thumbtack into the sacrum which unfortunately failed to penetrate the bone and bended. The patient continued to bleed when we attempted the combined use of a hemostatic sealant and an absorbable hemostat followed by gauze
Comments
Presacral venous bleeding is an uncommon but potentially life-threatening complication of rectal surgery with an incidence of 3% to 9.4%.3 It is more frequent in patients who undergo preoperative radiotherapy for rectal cancer3 or in patients who have had previous rectal surgery. Our percentage of 3.6 is in line with literature reports and also all 3 patients had a previous low ileorectal anastomosis for ulcerative colitis.
Traditional methods for stopping bleeding include pelvic packing and the
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