A condensation of the presacral fascia attaching the posterior rectal fascia to the anterior sacrum at the S4 level (Waldeyer's fascia or rectosacral ligament).
| Location | Back of the pelvis, behind the lower rectum |
|---|---|
| Boundaries |
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Anchors the lower rectum to the sacrum and must be divided to free the lower rectum in total mesorectal excision.
Waldeyer's fascia is divided sharply during total mesorectal excision (TME) to complete the posterior mesorectal dissection to the anorectal junction. Failure to recognise this structure leads to either entering the presacral space (bleeding from presacral veins) or breaching the mesorectum (positive circumferential margin). The presacral veins are particularly vulnerable at the S4 level.
Division of Waldeyer's fascia in the wrong plane tears the presacral venous plexus producing life-threatening presacral haemorrhage, managed by bone wax or haemostatic tacks over the sacral foramina.
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