Abstract
Background
Presacral venous hemorrhage is an uncommon but potentially life-threatening complication
of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional
hemostatic measures and several alternative methods for hemostasis have been proposed.
We described our experience of using the combination of a hemostatic matrix and an
absorbable hemostat as an alternative method of hemostasis.
Methods
From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer,
ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe
presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix
(FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA).
Results
Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss
was minimal and drain was removed on day 4 in all 3 patients.
Conclusions
The use of synthetic hemostatic agents is an effective and simple way to arrest presacral
bleeding where conventional methods fail.
Keywords
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References
- Anatomy of the presacral venous plexus: implications for rectal surgery.Surg Radiol Anat. 2004; 26: 355-358
- New consepts in severe presacral hemorrhage during proctectomy.Arch Surg. 1985; 120: 1013-1020
- Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.Dis Colon Rectum. 2004; 47: 1550-1553
- Newly designed occluder pin for presacral hemorrhage.Dis Colon Rectum. 1992; 35: 166-169
- Displacement and per-anal extrusion of a hemostatic sacral thumbtack.J Pelvic Med Surg. 2004; 10: 319-322
- Use of tissue expander for tamponade of presacral hemorrhage.Dis Colon Rectum. 1994; 37: 723-726
- Controlling a presacral hemorrhage by using a saline bag: report of a case.Dis Colon Rectum. 2008; 51: 972-974
- The use of bone wax to control massive presacral bleeding.Surg Today. 2002; 32: 944-945
- Muscle fragment welding for control of massive presacral bleeding during rectal mobilization.Dis Colon Rectum. 2003; 46: 1115-1117
- Muscle tamponade to control presacral venous bleeding.Dis Colon Rectum. 2002; 45: 1109-1111
- A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery.Spine. 2001; 26: 1645-1650
- Controlled clinical trial of a novel hemostatic agent in cardiac surgery.Ann Thorac Surg. 2000; 69: 1376-1382
- A low-cost and simple method to stop intraoperative leakage-type bleeding: use of the vancomycin-oxidized regenerated cellulose sandwich.J Invest Surg. 2006; 19: 323-327
Article info
Publication history
Published online: April 22, 2010
Received in revised form:
November 4,
2009
Received:
July 5,
2009
Identification
Copyright
© 2010 Published by Elsevier Inc.
