The use of thumbtacks to stop severe presacral bleeding

Massive presacral bleeding arising during gynaecological surgery can be sudden, rapid and life-threatening. Further, its control and management can be challenging, since standard measures are frequently ineffective. The use of thumbtacks to control severe presacral venous haemorrhage was first reported in 1985. Despite this, it does not appear to be widely known or used in gynaecological surgery. A case is presented in which the technique was used, and the literature on its use is reviewed.

Presacral bleeding; Thumbtack; Drawing pin; Haemorrhage

[1] Braley S.C., Schneider P.D., Bold R.J., Goodnight J.E. Jr., Khatn VP.: "Controlled tamponade of severe presacral venous hemorrhage; use of a breast implant sizer". Dis. Colon Rectum., 2002, 45, 140.

[2] Wang Q.Y., Shi W.J., Zhao YR., Zhou W.Q., He Z.R.: "New concepts in severe presacral hemorrhage during proctectomy". Arch Surg., 1985, 120, 1013.

[3] Nivatvongs S., Fang D.T.: "The use of thumbtacks to stop massive presacral hemorrhage". Dis. Colon Rectum., 1986, 29, 589.

[4] Khan FA., Fang D.T., Nivatvongs S.: "Management of presacral bleeding during rectal resection". Surg. Gynecol. Obstet., 1987, 165, 274 .

[5] Patsner B ., Orr J.W. Jr.: "Intractable venous sacral hemorrhage: use of stainless steel thumbtacks to obtain hemostasis". Am. J Obstet. Gynecol., 1990, 162, 452.

[6] Timmons M.C., Kohler M.F., Addison W.A.: "Thumbtack use for control of presacral bleeding, with description of an instrument for thumbtack application". Obstet Gynecol., 1991, 78, 313 .

[7] Barras J.P., Fellmann T: "Massive hemorrhage from presacral veins during resection of the rectum". Helv. Chir Acta., 1992, 59, 335.

[8] Sundaresan K.T., Sugirtha S., Devanarayana N .M., Ariyaratne M.H., Deen K.I.: "Prevention of presacral haemorrhage using thumb tacks". Ceylon Med J., 1999, 44, 87.

[9] Arnaud J.P., Tuech J.J., Pessaux P.: "Management of presacral venous bleeding with the use of thumbtacks". Dig. Surg., 2000, 17, 651 .

[10] Lucarotti M.E., Armstrong C.P., Bartolo D.C.: "Control of presacral bleeding in rectal surgery". Ann. R. Coll. Surg. Engl., 1991, 73, 289.

[11] Gostout B.S., Cliby W.A., Podratz K.C.: "Prevention and management of acute intraoperative bleeding". Clin. Obstet. Gynecol., 2002, 45, 481.

[12] Thiel I., Lang P.F.J., Tamussino K.F., Winter R.:'Thumbtack application for control of presacral hemorrhage at pelvic lymphadenectomy: a case report". J. Pelvic Surg., 2001, 7, 303.

[13] Rotondano G., Romano G .: "The use of thumbtacks in massive presacral bleeding". Am. J. Gastroenterol., 2000, 95, 1102.

[14] Yarze J.C.: "A'tacky'situation". Am. J. Gastroenterol., 1999, 94, 1984.

[15] McPartland K.J., Hyman N.H.: "Damage control: what is its role in colorectal surgery?". Dis. Colon Rectum., 2003, 46, 981.

[16] Stolfi V.M., Milsom J.W., Lavery l.C., Oakley J.R., Church J.M., Fazio V.W.: "Newly designed occluder pin for presacral hemorrhage". Dis. Colon Rectum., 1992, 35, 166.

[20] Harrison J.L., Hooks V.H., Pearl R.K., Cheape J.D., Lawrence M.A., Orsay C.P. et al.: "Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases". Dis. Colon Rectum., 2003, 46, 1115.

[17] Suh M., Shaikh J.R., Dixon A.M., Smialek J.E.: "Failure of thumbtacks used in control of presacral hemorrhage". Am. J. Forensic Med. Pathol., 1992, 13, 324.

[18] Remzi F.H., Oneel M., Fazio V.W.: "Muscle tamponade to control presacral venous bleeding: report of two cases". Dis. Colon Rectum., 2002, 45, 1109.

[19] Ayuste E. Jr., Roxas M.F.: "Validating the use of rectus muscle fragment welding to control presacral bleeding during rectal mobilization". Asian. J. Surg., 2004, 27, 18.

[20] Harrison J.L., Hooks V.H., Pearl R.K., Cheape J.D., Lawrence M.A., Orsay C.P. et al.: "Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases". Dis. Colon Rectum., 2003, 46, 1115.