Massive presacral bleeding during rectal surgery: From anatomy to clinical practice

Figure 1 Presacral vascular cast. A: Front view; B: Dorsal view.

Figure 2 Bleeding point originated from the presacral venous plexus and a sacral neural foramen where the basivertebral veins were injured. A: Continuous pressure over the bleeding site using a gauze nut at the tip of a long Kelly clamp; B: Venous branches surrounding the gauze nut could be identified, and were suture ligated one by one with 3-0 suture thread; C: Continuous pressure over the bleeding site using the epiploic appendices at the tip of a long Kelly clamp; D: Electrocautery applied through the epiploic appendices pressed with a long Kelly clamp over the bleeding vessel.

Figure 3 Process in the management of massive presacral bleeding.