Usefulness of Thumbtacks in Regulation for Massive Presacral Hemorrhage in Rectal Surgery: Report of a case

SUMMARY We encountered a case who had massive presacral hemorrhage during rectal surgery. The patient was 86‑year‑old woman having carcinoma located at upper to middle rectum. Low anterior resection was planned to treat. When the tumor fixed to the pelvic lateral wall was mobilized by sharp dissection massive bleeding occurred from presacral surface at S2 to S4 levels in the sacrum. Bleeding could not be easily controlled by conventional hemostatic maneuvers due to her narrow pelvis and heavy humpback. The only way to control bleeding was to press the fingertips on bleeding site which temporarily controlled the bleeding. With sterilized metallic thumbtacks through an abdominal approach bleeding was effectively controlled. There was no recurrence of bleeding and other complication in postoperative course. Thumbtacks is an useful tool to control massive presacral hemorrhage during rectal surgery.