Management of Massive Presacral Bleeding During Low Pelvic Surgery - An Alternative Technique

Abstract

Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. So, effective hemostasis is critical in severe presacral hemorrhage due to the fatal course of this complication. Among the reported methods are packing, thumbtacks, inflatable devices, muscle tamponade, muscle fragment welding and application of endoscopic staplers. Local hemostatic agents in conjunction with other methods such as diathermy, cyanoacrylate tissue adhesives and application of bone wax are among other alternatives which may help to treat this serious complication. The aim of this study is to describe the anatomic and physiologic basis of our mode of treatment, which is new in the literature approach, treating two patients with presacral bleeding during low anterior resection for rectal cancer. The technique is the early clamping of the infrarenal aorta and suture ligation of the bleeding points from the presacral plexus.

Zusammenfassung

Massive präsakrale Blutungen während der Rektummobilisation sind selten, können aber den Patienten in kürzester Zeit destabilisieren und letal enden. Eine sofortige effektive Hämostase ist daher unverzichtbar. Unter den beschriebenen therapeutischen Methoden finden sich Packing, Thumbtacks, aufblasbare Geräte, Muskeltamponade, die Verlötung von Muskelfragmenten und die Anwendung endoskopischer Stapler. Lokale Hämostyptika in Verbindung mit Methoden wie Diathermie, Cyanoacrylat-Gewebekleber und die Verwendung von Knochenwachs zählen zu den Alternativen, um diese schwere Komplikation zu beherrschen. Das Ziel dieser Studie ist, die anatomischen und physiologischen Grundlagen unserer Behandlungmethode zu beschreiben, die einen in der Literatur neuartigen Ansatz darstellt. Wir behandelten zwei Patienten mit präsakraler Blutung während tiefer anteriorer Resektion aufgrund eines Rektumkarzinoms. Die Technik besteht in einem frühen Abklemmen der infrarenalen Aorta und einer Nahtligatur der Blutungsquellen des präsakralen Plexus.

Key words

presacral bleeding - pelvic surgery - rectal surgery

Schlüsselwörter

präsakrale Blutung - Beckenchirurgie - Rektumchirurgie

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