The median sacral vein accompanies the median sacral artery on the anterior surface of the sacrum, draining into the left common iliac vein or the junction of the two common iliac veins. It receives tributaries from the sacral venous plexus and contributes to the paravertebral venous system.
The median sacral vein is injured during anterior sacral dissection in low anterior resection, sacrectomy, and anterior lumbosacral fusion. Its proximity to the sacral promontory makes it a bleeding risk during L5-S1 disc exposure. Preoperative CTA identifies anomalous venous anatomy before presacral dissection.
Tearing of the median sacral vein or presacral venous plexus during pelvic dissection producing rapid, difficult-to-control haemorrhage from the sacral foramina communicating vessels.
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