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.

An expanded entry for Presacral Fascia.

Anatomical Data

Boundaries & Contents

Location	Back of the pelvis, on the front of the sacrum and coccyx
Boundaries	Attached to the anterior surface of the sacrum and coccyx Continuous laterally with the parietal pelvic fascia Separated in front from the mesorectal fascia by the retrorectal space
Contents	Median sacral vessels and the presacral venous plexus lie behind it

Biomechanics

Function & Actions

Covers the presacral veins; staying in front of it in rectal surgery avoids severe bleeding.

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.

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