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Casal Núñez JE, Vigorita V, Ruano Poblador A, Gay Fernández AM, Toscano Novella M&A, Cáceres Alvarado N, Pérez Dominguez L. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol 2017; 23:1712-1719. [PMID: 28321171 PMCID: PMC5340822 DOI: 10.3748/wjg.v23.i9.1712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/26/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.
METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.
RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.
CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
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Holmer C, Kreis ME. Management of Complications Following Emergency and Elective Surgery for Diverticulitis. VISZERALMEDIZIN 2015; 31:118-23. [PMID: 26989382 PMCID: PMC4789908 DOI: 10.1159/000377696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. METHODS The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. RESULTS To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. CONCLUSION The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.
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Affiliation(s)
- Christoph Holmer
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Yoo BE, Lee DW, Lee SW, Kwak JM, Kim J, Kim SH. Transanal gauze packing to manage massive presacral bleeding secondary to prescral abscess caused by rectal anastomotic leakage: a novel approach. Ann Surg Treat Res 2015; 88:236-9. [PMID: 25844360 PMCID: PMC4384289 DOI: 10.4174/astr.2015.88.4.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 01/03/2023] Open
Abstract
Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis. To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature. We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.
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Affiliation(s)
- Byung-Eun Yoo
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Won Lee
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Won Lee
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Celentano V, Ausobsky JR, Vowden P. Surgical management of presacral bleeding. Ann R Coll Surg Engl 2014; 96:261-5. [PMID: 24780015 PMCID: PMC4574406 DOI: 10.1308/003588414x13814021679951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- V Celentano
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - JR Ausobsky
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - P Vowden
- Bradford Teaching Hospitals NHS Foundation Trust, UK
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Casal Nuñez JE, García Martinez MT, Ruano Poblador A, Sánchez Conde JA, Pampín Medela JL, Moncada Iribarren E, De Sanildefonso Pereira A. [Presacral haemorrhage during rectal cancer resection: morphological and hydrodynamic considerations]. Cir Esp 2012; 90:243-7. [PMID: 22405887 DOI: 10.1016/j.ciresp.2011.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Our aim is to identify the location and size of the anterior foramina of sacral vertebral bodies and analyse the haemodynamic variables that could influence the haemorrhagic severity of the injury of the presacral venous plexus. MATERIALS AND METHODS Using computed axial tomography the morphological data of 70 sacral bones in 67 patients with rectal cancer were recorded, as well as measuring the height between the vena cava and S5. After transfemoral catheterisation the inferior vena cava pressure was recorded in 10 patients with rectal cancer. Hydrodynamic principles, according to Bernoulli's Law, were applied to calculate sacral venous plexus pressure, and the flow rate according to the calibre of a hypothetical venous injury. RESULTS The maximum diameter ranged from 0.5mm to 4mm in 22% of the cases. All foramina of 2 or more millimetres were located in the S4-S5 region. Sacral plexus venous pressure in lithotomy was almost double the inferior vena cava pressure in normal position. Blood flow ranged from 498 to 1,994 ml/min for injuries of sizes between 2 and 4mm, respectively. CONCLUSIONS Larger calibre foramina are found in vertebral bodies of S4-S5. Venous injury at these levels can reach a flow rate of 2 l/min.
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[Damage control surgery in abdominal trauma]. ACTA ACUST UNITED AC 2010; 57:15-24. [PMID: 20681194 DOI: 10.2298/aci1001015k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The damage control laparotomy is an advancement in the management of massively injured trauma patients. Massive liver injuries, pelvic trauma and some retroperitoneal injuries are some of the indications for this approach. The damage control laparotomy is the phased approach to severe abdominal injury that might best be described with the acronym STIR (Staged Trauma Injury Repair). The initial procedure requires rapid abdominal exploration with hemorrhage and contamination control, using suture repair combined with abdominal packing. Temporary abdominal wall closure without tension is recommended. After abrevated initial surgical procedure, the patient is transferred to the intensive care unit where continued resuscitation is performed. Careful replacement of blood and blood products along with correction of hypothermia, acidosis and optimalization of oxygen transport represents a critical phase in this management approach. Once the coagulation profile has normalized, planned re-intervention, with repeat abdominal exploration to remove the packs and perform definitive surgical repair and reconstruction takes place. When applied judiciously, the damage control laparotomy with the staged abdominal repair and reconstruction for severe trauma is associated with an improved outcome in the selected group of patients.
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Hammond KL, Margolin DA. Surgical hemorrhage, damage control, and the abdominal compartment syndrome. Clin Colon Rectal Surg 2010; 19:188-94. [PMID: 20011320 DOI: 10.1055/s-2006-956439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The morbidity and mortality associated with surgical hemorrhage are considerable, particularly when relaparotomy is necessary. This complication can usually be avoided with comprehensive preoperative patient evaluation and meticulous surgical technique. The damage control sequence is a useful surgical strategy when severe intraoperative coagulopathy or hemodynamic instability is present. Abdominal compartment syndrome is a potentially lethal phenomenon that can occur following laparotomy or large-volume fluid resuscitation, or both. Early recognition and intervention are critical to survival of the patient when this syndrome occurs.
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Affiliation(s)
- Kerry L Hammond
- Department of Colon and Rectal Surgery, The Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Abstract
We report the case of a 70-year-old woman who had previously undergone anterior resection in 2001 for a diverticular stricture. Bleeding from pelvic veins intra-operatively necessitated the use of two thumbtacks to aid haemostasis. Over the next 7 years, she presented repeatedly with anal pain, bleeding and mucus discharge per rectum. Multiple lower gastrointestinal endoscopies failed to make a definitive diagnosis until a single thumbtack was found eroding through the rectal mucosa. This was removed and she has been subsequently asymptomatic. This condition was clearly difficult to diagnose and requires a high index of suspicion in those patients who have previously undergone pelvic surgery.
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Affiliation(s)
- Adam Charles Critchley
- Department of General Surgery, Wansbeck General Hospital, Ashington, Northumberland, UK.
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Kumar S, Malhotra N, Chumber S, Gupta P, Aruna J, Roy KK, Sharma JB. Management of presacral venous bleeding with the use of thumbtacks. Dig Surg 2007; 276:385-6. [PMID: 17347833 DOI: 10.1007/s00404-007-0344-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 02/15/2007] [Indexed: 12/30/2022]
Abstract
Massive bleeding from the sacral basivertebral vein is uncommon and can be fatal because conventional methods to control the bleeding are often futile. The authors report an effective technique of the occlusion of the bleeding site with a thumbtack.
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Affiliation(s)
- Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, 9/22 AIIMS, New Delhi, India
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12
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Dunn JH, Goldberg BA, Kim A, An G. Control of presacral hemorrhage after penetrating trauma: a new technique. ACTA ACUST UNITED AC 2007; 63:197-201. [PMID: 17622891 DOI: 10.1097/ta.0b013e3180341f3c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan H Dunn
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Filippakis GM, Leandros M, Albanopoulos K, Genetzakis M, Lagoudianakis E, Pararas N, Konstandoulakis MM. The Use of Spray Electrocautery to Control Presacral Bleeding: A Report of Four Cases. Am Surg 2007. [DOI: 10.1177/000313480707300422] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bleeding originating from the presacral venous plexus during pelvic operations is difficult to control, constituting a potentially life-threatening complication. Although suture ligatures, packing, and placement of tacks are established hemostatic techniques, they are often proved to be ineffective. We report a simple novel technique using spray diathermy for managing this severe complication. We have applied our method in four patients, two undergoing low anterior resection, and the others undergoing abdominoperineal resection for rectal cancer, that manifested severe presacral bleeding during rectal mobilization. Electrocautery at spray setting was applied slightly above the target bleeders at the presacral fascia, delivering a high-frequency electrical current in combination with drainage suction. In all cases, the method resulted in successful hemostasis. Applying spray electrocautery is a simple and effective method for controlling pre-sacral bleeding. The advantages of using such a method instead of conventional hemostatic techniques include the option of varying the degree of haemostatic effect by altering the frequency and the volume of electric current.
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Affiliation(s)
- George M. Filippakis
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Manolis Leandros
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Kostas Albanopoulos
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Michael Genetzakis
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Emmanuel Lagoudianakis
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Nikos Pararas
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
| | - Manousos M. Konstandoulakis
- First Department of Propaedeutic General Surgery, Athens University Medical School, Hippocrateion Hospital, Q. Sophia 114, 11527, Athens, Greece
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Mlynček M, Uharček P, Obert A. The Management of a Life-Threatening Pelvic Hemorrhage in Obstetrics and Gynecology. J Gynecol Surg 2005. [DOI: 10.1089/gyn.2005.21.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miloš Mlynček
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
| | - Peter Uharček
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
| | - Adrián Obert
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
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15
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Lacerda-Filho A, Dur??es LC, Santos HFT. Displacement and Per-Anal Extrusion of a Hemostatic Sacral Thumbtack. ACTA ACUST UNITED AC 2004. [DOI: 10.1097/01.spv.0000156966.23479.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Baqué P, Karimdjee B, Iannelli A, Benizri E, Rahili A, Benchimol D, Bernard JL, Sejor E, Bailleux S, de Peretti F, Bourgeon A. Anatomy of the presacral venous plexus: implications for rectal surgery. Surg Radiol Anat 2004; 26:355-8. [PMID: 15300413 DOI: 10.1007/s00276-004-0258-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.
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Affiliation(s)
- P Baqué
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, 06000 Nice, France.
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17
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Ayuste E, Roxas MFT. Validating the use of rectus muscle fragment welding to control presacral bleeding during rectal mobilization. Asian J Surg 2004; 27:18-21. [PMID: 14719509 DOI: 10.1016/s1015-9584(09)60238-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The incidence of presacral bleeding during rectal mobilization is low, but such bleeding may be massive and even fatal. Haemostasis can be difficult to achieve using conventional methods because of the complex interlacing of the venous network at the sacral periosteum. Historically, pelvic packing and metallic thumbtacks have been the more commonly used methods in our institution. However, the need for repeat surgery to remove the packs and the difficulties encountered in tack application have forced us to explore other methods. In 1994, the procedure termed muscle fragment welding, which uses electrocautery through a rectum muscle fragment, was introduced to control presacral bleeding. From January 1999 to February 2002, six of 416 patients undergoing pelvic surgery in our institution developed massive presacral haemorrhage and therefore, this technique was used. Haemostasis was immediate and permanent. No major untoward postoperative events such as re-bleeding or infection were noted. One cas developed a second-degree burn in the right elbow due to a misplaced ground conduction plate. Rectus muscle fragment welding is , in our experience, an effective and practical method of controlling presacral haemorrhage.
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Affiliation(s)
- Edwardo Ayuste
- Dicidion of Colorectal Srger, Departmento fo Surgery, University of the Philippines--Philippines General Hospital Medical center, Manila,1000, Philippines
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18
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Pessaux P, Tuech JJ, Hennekinne S, Régenet N, Arnaud JP. [The use of occluder pin in severe presacral hemorrhage]. ANNALES DE CHIRURGIE 2001; 126:1019. [PMID: 11803625 DOI: 10.1016/s0003-3944(01)00651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- P Pessaux
- Service de chirurgie viscérale, CHU Angers, 4, rue Larrey, 49033 Angers, France
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Cosman BC, Lackides GA, Fisher DP, Eskenazi LB. Use of tissue expander for tamponade of presacral hemorrhage. Report of a case. Dis Colon Rectum 1994; 37:723-6. [PMID: 8026241 DOI: 10.1007/bf02054419] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A silastic tissue expander has been used to tamponade severe presacral hemorrhage in a patient undergoing abdominoperineal resection for rectal carcinoma. This technique may be applicable in similar cases when tamponade is required for uncontrolled venous hemorrhage. The presence of an expandable pelvic prosthesis may be of use postoperatively in avoiding radiation-associated small bowel injury.
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Affiliation(s)
- B C Cosman
- Department of Surgery, Kaiser Permanente Medical Center, Santa Clara, California
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22
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Russell AJ, Andaz SK, Ward AS, Rees M. Use of Blount's epiphyseal staples to control massive iliac venous haemorrhage. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:403-5. [PMID: 8481142 DOI: 10.1111/j.1445-2197.1993.tb00410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Significant injuries to major veins are life-threatening events and may lead to patient exsanguination. Treatment usually consists of direct suture repair. A case in which a serious iliac venous haemorrhage was not able to be controlled with the usual surgical procedures is reported. A desperate attempt to achieve haemostasis using orthopaedic staples was successful. The simplicity of this technique makes it a useful addition to the surgeon's armamentarium when dealing with life-threatening venous haemorrhage.
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Affiliation(s)
- A J Russell
- Basingstoke District Hospital, Hampshire, United Kingdom
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23
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Abstract
Current understanding of the routes of spread of rectal cancer along with technical innovations such as the circular stapler have allowed surgeons to treat most rectal cancers with an anterior resection and low anastomosis. Appropriate use of local therapy options has further decreased the need for abdominoperineal resection (APR). Nonetheless, APR remains the procedure of choice for many distal rectal adenocarcinomas. Numerous factors influence the decision to perform an APR and are discussed in detail. Although mortality for APR has been reduced significantly, morbidity remains high. Specific complications commonly seen after APR are discussed. Operative technique is outlined since much of the specific morbidity of APR can be reduced by attention to detail in the conduct of this complex procedure.
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Affiliation(s)
- D A Rothenberger
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis
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24
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Stolfi VM, Milsom JW, Lavery IC, Oakley JR, Church JM, Fazio VW. Newly designed occluder pin for presacral hemorrhage. Dis Colon Rectum 1992; 35:166-9. [PMID: 1735319 DOI: 10.1007/bf02050673] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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25
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Schoetz DJ. Complications of surgical excision of rectum. Surg Clin North Am 1991; 71:1271-81. [PMID: 1948574 DOI: 10.1016/s0039-6109(16)45590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgical excision of all or part of the rectum remains a formidable technical challenge for the surgeon and a source of substantial morbidity and mortality for the patient. Most complications are avoidable by meticulous attention to the technical details in the performance of the operation. However, even in the best of circumstances, these procedures are accompanied by complications. An understanding of the mechanisms of these complications combined with a realistic approach to their diagnosis and solution will minimize the impact on ultimate results.
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Affiliation(s)
- D J Schoetz
- Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts
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Sharma A. Myxopapillary ependymomas arising from nerve roots of the spinal cord. J Neurol Neurosurg Psychiatry 1991; 54:563-4. [PMID: 1880528 PMCID: PMC488608 DOI: 10.1136/jnnp.54.6.563-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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27
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Morris KM, Findlay GF. Spinal extradural venous haemorrhage controlled by a drawing pin: a new technique in neurosurgery. J Neurol Neurosurg Psychiatry 1991; 54:564. [PMID: 1880529 PMCID: PMC488609 DOI: 10.1136/jnnp.54.6.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
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.
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Affiliation(s)
- P P Metzger
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida 32224
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