eP484 - Presacral Hemorrhage: A New Way to Tame the Beast

ePoster Moderator(s)

• YR

  Yvette Rodriguez, MD

  PGY III
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina, United States

  Disclosure information not submitted.

Author(s)

• HL

  Hanah Lee, MPH, MD

  General Surgery Resident
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina, United States

  Disclosure information not submitted.

Author(s)

• 

  Natalie Cuevas, MD

  PGY I
  Novant Health New Hanover Regional Medical Center
  Novant Health New Hanover Regional Medical Center
  Winnabow, NC, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• WS

  Whiyie A. Sang, MD

  Division of Colon and Rectal Surgery
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina, United States

  Disclosure information not submitted.
• SF

  Sarah S. Fox, MD

  Division of Colon and Rectal Surgery
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina, United States

  Disclosure information not submitted.

Senior Author(s)

• JP

  Joseph Payne, MD

  Division of Colon and Rectal Surgery
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina, United States

  Disclosure information not submitted.

Purpose/Background: Reoperative pelvic surgery can be quite tedious, especially if the presacral space is not well-defined.  A difficult mesorectal dissection can be secondary to complex anatomy, infection, radiation, and reoperative pelvic surgery.  One of the most dreadful scenarios is uncontrollable presacral bleeding.  Although rare, such bleeding poses a significant challenge and can even be life-threatening. Here we present a case of a difficult presacral bleeder that was not controlled by standard modalities.Methods/Interventions: This is a 64-year-old woman with an initial diagnosis of Ulcerative Colitis who underwent a Restorative Proctocolectomy with Ileoanal Pouch Anal Anastomosis (IPAA) in 1989.  Her diagnosis was then transitioned to Crohn’s Disease once she developed fistulizing disease to her pouch.  We proceeded to take the patient for an Open Excision of J-pouch.  As expected, the pelvic dissection was exceedingly difficult due to the reoperative nature of the surgery.  Unfortunately, a large volume of presacral bleeding was encountered.  We attempted direct pressure, hemostatic agents, electrocautery, ProTack device usage, and cauterizing rectus muscle over the bleeding; all were unsuccessful.  We then proceeded to use a Richards Orthopedic Stapler which allowed for tamponade of the bleeding, while also securing a sheet of Nu Knit Surgicel unto the source of bleeding with the staple itself.Results/Outcomes: This was successful in obtaining hemostasis.  We were then able to complete the operation.  Her postoperative course was uneventful.Conclusion/

Discussion: Although an off-label use of the Richards Orthopedic Stapler, it proved effective in achieving hemostasis for presacral bleeding, offering a potential solution for challenging hemostasis management.Richards Stapler