PMC2633451_01
Computerised tomography (CT) scout film showing the placement of
the surgical tacks in the sacrum.
AU2009-978038.001.jpg
PMC2633451_01_AU2009-978038.001.jpg
fig1
Attempts to control the bleeding with packing and suturing were unsuccessful; three sterile surgical metallic tacks (pins) were inserted into the sacrum to compress the veins and stop the bleeding (Figure 1).
This is an illustration of the cold cut biopsy forceps passing
through the anastamotic defect, and removing the tacks in the sacrum.
AU2009-978038.002.jpg
PMC2633451_01_AU2009-978038.002.jpg
fig2
The edge of the circular tack (pin) was difficult to pick up with the biopsy forceps and the pin had to be levered of the sacrum by applying counter pressure on the sacrum (Figure 2).  All 3 tacks were successfully removed although the patient did feel some discomfort during the procedure due to pressure on the sacrum during pin removal.
(a) CT precystoscopic tack removal. Note the thick
walled presacral collection. (b) CT post cystoscopic tack removal. Although the improvement
in pre-sacral soft tissue thickening and fluid collection is minimal, the
patient was clinically much improved.
AU2009-978038.003.jpg
PMC2633451_01_AU2009-978038.003.jpg
fig3
The patient had a follow-up CT scan of her abdomen on 24/10/2007 and although the presacral collection improvement was minimal from a previous CT scan 4 months earlier (Figure 3), clinically the patient was much improved.