Anatomy of the presacral venous plexus: implications for rectal surgery

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.

Die bildwandergestützte, perkutane transiliosakrale Schraubenfixation instabiler Beckenverletzungen

“…Eine Perforation der ventralen Sakrumkortikalis kann zu Verletzungen der Vasa iliaca communia und des präsakralen Venenplexus führen [1]. tomically, a relatively high position of the sacral wing in relation to the iliac crest is found, as well as the presence of mammillary processes and joint connections between lumbar and sacral transverse processes [45].…”

“…If the anterior sacral cortex is perforated, this may cause damage to the common iliac vessel and the presacral venous plexus [1].…”

Giant cell tumors of the sacrum treated with intralesional resection and radiotherapy: a case series and review of the literature

“…As with GCTs in other locations, the treatment of choice is function-preserving surgery [5]. While complete surgical excision is considered to be the most efficient treatment, it is technically demanding and can result in substantial functional deficits [7][8][9] and even death.…”

Surgical management of presacral bleeding

“…13 The most likely area of injury is the lower sacrum, where Waldeyer's fascia is thick and may attach directly to the presacral fascia. As this entire pelvic venous system lacks valves, 15 it has been estimated that with the patient in the lithotomy position, the hydrostatic pressure in the presacral space is up to three times that of the inferior vena cava. 16 Experimental studies have demonstrated that blood loss from presacral veins measuring 2-4mm in diameter can reach up to 1,000ml/min and increasing the diameter of the vein by just 1mm can increase the blood loss almost threefold.…”