Presacral Bleeding Research Articles

Damage control: what is its role in colorectal surgery?

Damage control is an approach that has gained widespread popularity and acceptance in the management of severely injured patients. Although initially popularized in the trauma literature, this technique is being expanded to the management of a broad range of serious, often desperate surgical circumstances that may be encountered, including scenarios confronted by the colon and rectal surgeon. Damage-control surgery is a three-staged process involving a truncated laparotomy, aggressive resuscitation in the intensive care unit, and finally, definitive surgery. This approach may be lifesaving in the setting of presacral hemorrhage, severe coagulopathy, or patient instability.

Cyanoacrylate adhesive in management of severe presacral bleeding.

Effective hemostasis is critical in severe presacral hemorrhage because the bleeding may be fatal. We report our successful use of combined hemostatic sponge and cyanoacrylate glue in three patients with life-threatening presacral hemorrhage after abdominoperineal resection of the rectum for carcinoma.

Bipolar Electrocoagulation Is Useful for Control of Intractable Presacral Hemorrhage During Abdominal Radical Hysterectomy

ABSTRACT Presacral hemorrhage during pelvic surgery is usually difficult to control. We here report our experience in controlling intractable presacral hemorrhage by using bipolar electrocauterization in four patients with cervical carcinoma. During radical hysterectomy, presacral hemorrhage occurred in these four patients and failed to be controlled by conventional maneuvers, such as compression with digit or gauze or suture ligation of the bleeding areas or both. The amount of estimated blood loss exceeded 3000 ml in each patient. Satisfactory hemostasis was achieved by bipolar electrocoagulation of the bleeding areas with Kleppinger forceps. Presacral hemorrhage was well controlled in all cases, without obvious complications. (J GYNECOL SURG 13:89, 1997)

Balloon tamponade for control of massive presacral haemorrhage

Balloon tamponade for control of massive presacral haemorrhage

Balloon tamponade for control of massive presacral haemorrhage

Massive pelvic bleeding during mobilization of the distal rectum is a recognized complication1, and can be difficult to control. A technique for dealing with this complication, involving pelvic venous tamponade with a perineal Sengstaken-Blakemore tube is described.

Intraoperative reasons for abandoning ileal pouch-anal anastomosis procedures.

Ileal pouch-anal anastomosis (IPAA) has become the operation of choice for most patients with chronic ulcerative colitis and familial adenomatous polyposis. However, because of technical or disease factors at the time of pouch construction, IPAA must sometimes be abandoned. A retrospective review was conducted to find reasons for IPAA failure or abandonment. Since 1981, 103 patients have had to have an IPAA procedure at the George Washington University Medical Center in Washington, DC. All charts were reviewed and data retrospectively collected. Six of 103 patients (six percent) were unable to have IPAA constructed. Five patients ultimately received a standard end ileostomy, and one had an ileorectal anastomosis. The reasons for abandoning the IPAA procedure were an ischemic pouch, failure to reach the anus, poorly controlled presacral hemorrhage, desmoid of the mesentery, and finding incurable colon carcinoma. Information regarding the risk of failure or abandonment during the IPAA procedure should be discussed with the patient during preoperative counseling and must be included as an element of informed consent.

Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications.

The aim of this study was to determine the incidence and risk factors that were significant in contributing the intraoperative and early postoperative complications for operations of carcinoma of the rectum. Between 1984 and 1986 inclusive, 426 patients underwent surgery for primary adenocarcinoma of the rectum. Cases of local excision were excluded. The relationship between each complication and nominal risk factors were studied. The types of surgery included an abdominoperineal resection, low anterior resection, low anterior resection with coloanal anastomosis, anterior resection, colostomy, and Hartmann's procedure. There were two (0.5 percent) deaths. Intraoperative complications occurred in 34 (8 percent) patients. The most common intraoperative complication was presacral bleeding which occurred in 14 patients. Postoperative complications occurred in 214 (50 percent) patients. The two most common complications were urinary retention and urinary tract infection. Abdominoperineal resection had the highest early postoperative complication rate (59 percent). There were 17 clinical anastomotic leaks (7 percent in 221 patients with unprotected anastomoses). The development of complications reached statistical significance with increasing age (P = 0.003), male sex (P = 0.003), increasing weight (P = 0.006), and types of operative procedure (P = 0.001). Operations for carcinoma of the rectum can be performed with low mortality. Although the overall early postoperative complications were high, the majority was not life-threatening and usually resolved with time and proper management.

Newly designed occluder pin for presacral hemorrhage

Conventional hemostatic measures are often unsatisfactory in presacral venous bleeding occurring during surgical mobilization of the rectum. We designed a new type of hemorrhage occluder pin, with a ridged shaft, which may be rapidly placed into the sacrum to control hemorrhage. The aims of this study were 1) to assess the best pin shaft length by measuring the thickness of human sacral vertebral bodies, 2) to measure the forces needed to pull the newly designed pin out of the human sacrum compared with conventionally shaped titanium thumbtacks, and 3) to assess clinically the efficacy of the new device. Four fresh cadaveric pelves were isolated and cut on a sagittal plane, and the thickness of each vertebral body was measured. Titanium pins, both with ridged and with smooth shafts, were used. Twelve-millimeter-shaft pins were used for S1 and S2, and 7-mm pins were used for S3, S4, and S5. Pins were inserted into each sacral vertebra, and the forces needed to extract them from the bone were measured by computerized dynamometry. Significantly more force was required to extract ridged vs. smooth pins, both with 12-mm and with 7-mm shafts. There was no significant difference between the forces needed to pull out 12-mm vs. 7-mm pins. The new pin was successfully used to stop presacral hemorrhage in three patients with no complications one, three, and six months after surgery. This newly designed hemorrhage occluder pin may represent an improved method of controlling presacral venous hemorrhage.

直腸癌手術時の仙骨前出血に対する画鋲型止血ピンを用いた止血法

直腸癌手術時の仙骨前出血に対する画鋲型止血ピンを用いた止血法

Modified packing technique for control of presacral pelvic bleeding

A modification of pelvic packing to control presacral bleeding is described. This method makes removal of the packing less uncomfortable and usually does not require anesthesia.

New concepts in severe presacral hemorrhage during proctectomy.

In the past, surgeons thought that severe presacral hemorrhage during proctectomy was caused by damage of the presacral venous plexus. By studying the anatomy and clinical data, we found that injury of the sacral basivertebral vein also caused this serious complication. Presacral hemorrhage is seen as massive bleeding from the distal pelvic surface of sacrum or from one to several large-caliber foramina of sacral basivertebral veins in that area. This type of presacral hemorrhage is more dangerous than that from simple injury of presacral venous plexus and sometimes it is fatal. We describe the anatomic features of the vertebral venous system and its close relationship with severe presacral hemorrhage. We also propose some new concepts about cause, hemostatic measures, and principles of prevention.

Traumatic presacral hemorrhage: angiographic diagnosis and therapy.

Presacral hemorrhage commonly accompanies fractures of the posterior pelvic ring. The source of this bleeding is the fractured cancellous bone and supporting ligamentous structures of the sacrum and sacroiliac joint. The radiologic appearance is of granular and punctate contrast accumulations due to extravasation from the iliolumbar and lateral sacral branches of the hypogastric artery. This bleeding can be controlled by small particle embolotherapy provided care is taken not to bypass the posterior division of the hypogastric artery.