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Surgical management of presacral bleeding
#MMPMID24780015
Celentano V
; Ausobsky JR
; Vowden P
Ann R Coll Surg Engl
2014[May]; 96
(4
): 261-5
PMID24780015
show ga
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.
|Administration, Topical
[MESH]
|Blood Loss, Surgical/*prevention & control
[MESH]
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