Tamponade of Presacral Hemorrhage With Hemostatic Sponges Fixed to the Sacrum With Endoscopic Helical Tackers: Report of Two Cases

Background: Management of presacral hemorrhage has always been a challenge for surgeons because such bleeding can rapidly destabilize the patient. Traditional methods like electric cauterization and suture ligation often fail and can aggravate bleeding.Methods: We report the case of a severe presacral hemorrhage that occurred during an ultra low rectal resection for cancer in a male patient.Results: After failing of electric cauterization and suture ligation the hemorrhage was successfully treated with pelvic packing.Conclusions: Coagulation and suturing should be avoided because they can aggravate bleeding resulting in significant blood loss. Pelvic packing is the treatment of choice in our experience.

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“…Presacral venous bleeding is an uncommon but potentially life-threatening complication of rectal surgery with an incidence of 3 to 9.4% [3].…”

Section: Discussionmentioning

confidence: 99%

“…It is more frequent in patients who undergo preoperative radiotherapy for rectal cancer [3]. Anatomical relationships of pelvic structures are widely modified after radiotherapy; the cellular lapse tissue around the rectum becomes strong and tenacious sticking to small pelvic structures mainly to the posterior presacral fascia.…”

Section: Discussionmentioning

confidence: 99%

Pelvic packing: a rescue treatment for severe presacral hemorrhage

et al. 2011

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“…They include muscle welding [3], thumbtacks [4,5], cyanoacrylate glue [6] and bone wax [7]. The use of helical tacks to control sacral bleeding has also been described [8]. We report the successful use of these tacks over Teflon Ò pledgets, at bleeding sites, to achieve permanent hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Control of presacral venous bleeding with helical tacks on PTFE pledgets combined with pelvic packing

Joseph

Perakath

2010

Tech Coloproctol

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“…Van der Vurst et al used a ProTack™ device (Covidien, Dublin, Ireland) to fix to the sacrum haemostatic sponges with endoscopic helical tackers. 33 This long and thin device is used extensively in laparoscopic hernia surgery and tacks can be applied with minimal obstruction of visibility.…”

Section: Tacking Techniquesmentioning

confidence: 99%

Surgical management of presacral bleeding

Celentano

Ausobsky

Vowden

2014

annals

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INTRODUCTION Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer's fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. METHODS A systematic search of the MEDLINE ® and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. RESULTS A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. CONCLUSIONS As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.

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Tamponade of Presacral Hemorrhage With Hemostatic Sponges Fixed to the Sacrum With Endoscopic Helical Tackers: Report of Two Cases

Cited by 48 publications

References 11 publications

Pelvic packing: a rescue treatment for severe presacral hemorrhage

Pelvic packing: a rescue treatment for severe presacral hemorrhage

Control of presacral venous bleeding with helical tacks on PTFE pledgets combined with pelvic packing

Surgical management of presacral bleeding

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