Abstract
The aim of this study was to investigate the features of intraoperative massive bleeding during procedures in the pelvic space. We studied 322 consecutive patients from 1998 to 2002 who sustained massive blood loss (>500ml) during abdominal surgery. The patient group consisted of 175 cases of digestive or gynecological malignancy, 35 of injury, 30 of aortic aneurysm, 17 of hepatic/pancreatic malignancy, 11 of perforated peptic ulcer, 10 of cholecystitis, 9 of bowel obstruction, 9 of benign colonic tumor, 4 of perforated acute appendicitis and 22 of other diseases. Seventy-eight (24.2%) of these patients underwent surgery in the pelvic space. The operative maneuvers related to the bleeding included lymph node dissection for cancer in 34 patients, presacral dissection in 18, adhesiotomy in 12, resection of advanced cancer in 10, dissection of the adjacent plexus to the prostate/vagina in 4 and others in 10. All the patients who sustained massive bleeding from the presacral plexus had rectal/sigmoid colonic cancer. In terms of correlation between the blood loss and operation time, the presacral bleeding is almost identical to the bleeding caused by other dissecting maneuvers in the pelvic space. Our results suggested that lymph node dissection could also be another major cause of massive intraoperative bleeding in addition to presacral dissection.
