During an anterior resection for rectal cancer, the surgeon enters the presacral space and encounters profuse venous bleeding from the presacral veins. The most appropriate immediate maneuver is:

• A Suture ligation of the vessels
• B Bipolar diathermy to the sacral foramina
• C Packing with a surgical sponge and applying thumbtack (sterile drawing pin) hemostasis ✓
• D Ligation of the common iliac artery

Explanation

Presacral venous bleeding (from basivertebral veins) is notoriously difficult to control with conventional methods because the veins retract into the sacral foramina. Suture ligation and diathermy are ineffective on retracted foraminal veins and can worsen bleeding. The standard emergency technique is to use sterile thumbtacks (stainless steel drawing pins) hammered directly into the sacral foramina to tamponade the vessel, followed by packing. This controls bleeding in over 90% of cases.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.