Presacral Fascia Detail

fascia praesacralis detail

The presacral fascia is the parietal layer of the endopelvic fascia covering the anterior sacrum and coccyx and the presacral vessels. It is the posterior boundary of the mesorectal envelope in total mesorectal excision.

Region: Abdomen

Biomechanics

Function & Actions

Provides the posterior wall of the presacral space, separates the mesorectal envelope from the sacral periosteum and presacral plexus, and is the reference plane for the posterior dissection in rectal surgery.

Clinical Relevance

Clinical Notes

The presacral fascia is the critical layer protecting the presacral venous plexus during rectal surgery — violation of this fascia results in massive presacral bleeding from the sacral basivertebral veins, which can be difficult to control. The correct TME plane stays anterior to the presacral fascia throughout the posterior dissection.

Pathology

Common Injuries & Conditions

Presacral Haemorrhage from Fascia Violation

Entry into the presacral space deep to the fascia during TME or APR, causing massive haemorrhage from basivertebral veins, controlled by packing, thumbtack haemostatic clips, or topical haemostatic agents.

Correct TME Plane Anterior to Presacral Fascia

The posterior dissection of total mesorectal excision must stay anterior to the presacral fascia to protect the presacral plexus and avoid catastrophic venous bleeding.