Presacral

Edema is usually first detected in the feet or pretibial area in ambulatory patients and in the presacral area in bed-bound individuals. Edema is defined as pitting when the depression caused by briefly exerting pressure over a bony prominence does not rapidly refill. 

A 68-year-old woman with Candida glabrata isolated from a presacral abscess developed torsade de pointes after 8 days treatment with oral fluconazole 150 mg/day (32). She had no other risk factors for torsade de pointes, including coronary artery disease, cardiomyopathy, congestive heart failure, or electroljde abnormalities. The dysrhythmia resolved when fluconazole was withdrawn, but she continued to have ventricular extra beats and non-sustained ventricular tachycardia for 6 days. 

Carty HML (2002) Paediatric emergencies non-traumatic abdominal emergencies. Eur Radiol 12 2835-2848 Clatworthy H, Howard W, Lloyd J (1956) The meconium plug syndrome. Surgery 39 132-141 Currarino G, Coin D, Votteler T (1980) Triad of anorectal, sacral and presacral anomalies. AJR Am J Roentgenol 137 395-398... 

Our option Small space between presacral fascia and sacral and coccygeal vertebrae containing vessels... 

A small presacral subcompartment (see Table 1.1) is situated in front of the sacrum and coccyx. It is bordered by the caudal segments of the vertebral column dorsally and ventrolaterally, it is clearly demarcated by the pelvic parietal fascia (see Table 1.1) (Fig. 1.2), which is called presacral fascia (see Table 1.1) at this position. In fetuses, the presacral subcompartment contains loose connective tissue, but it is predominated by large presacral veins. 

What is situated outside the rectal fascia and therefore outside the perirectal subcompartment Dorsally, the presacral subcompartment is loosely attached to the perirectal compartment (see above). Laterally the supplying structures (autonomic nerves and branches of the iliac vessels) of the urogenital organs constitute a nerve-vessel plate (Fig. 1.3c). The latter is accompanied by connective tissue and fills the remaining space between the perirectal compartment... 

Fig. 1.2a-

Fig. 7.34a-d. Lymph node staging. Stages of metastatic spread to the lymph nodes in cervical cancer, a Parametrial nodes, b Nodes along the external and common iliac arteries, c Presacral nodes, d Para-aortic nodes (regarded as distant metastases) (from [134])... 

Posterior tumor growth leads to infiltration of the presacral space and sacral bone or of the perirectal space and rectum. Recurrent cervical cancer is associated with rectal infiltration in about 17% of cases. The most common site is the rectosigmoid junction. Laterally, recurrent tumor may extend to the pelvic sidewall. If the recurrent local tumor grows anteriorly along the peritoneal fold, there will be infiltration of the urinary bladder. Advanced recurrent cervical cancer may involve the remaining colon or the small intestine and is typically associated with adhesion of bowel loops and may cause intestinal obstruction. 

Depending on the location of a pelvic fluid collection, different access paths determined by the surrounding pelvic ring are suitable the presacral approach (patient in prone position) is especially useful in patients who develop a presacral abscess after an abdominoperineal resection (Fig. 37.13). Using a sUght (double) angula-... 

Fig. 37.13a,b. Patient (prone position) with a fever showing a presacral fluid collection 10 days after abdominoperineal rectum resection (a). An 8-French drainage catheter was inserted using the Seldinger technique, b Guide wire being introduced through an 18-G sheath under CT fluoroscopy... 

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