CASE SUMMARY: 

An 84-year-old male patient was complaining of constipation and rectal bleeding for 6 months. Colonoscopy and rigid sigmoidoscopy showed a posterior upper rectal mass (13 cm from anus). Histopathology confirmed moderately differentiated adenocarcinoma. A CT scan of the thorax, abdomen, and pelvis, as well as pelvic magnetic nuclear resonance imaging, revealed midrectal cancer cT3N0M0 with clear predicted circumferential margin. The patient underwent anterior resection with tumor-specific total mesorectal excision and end colostomy. During the posterior rectal dissection, dilated fragile varicose presacral veins were damaged, and severe bleeding was observed. Initial pelvic packing was ineffective, as well as bone wax and clips. Internal iliac arteries were ligated, and additional packing was finally successful and the bleeding stopped. The patient was resuscitated with a total blood loss of 4.2 L. The bleeding did not recur, and the packs were removed on postoperative day 2. The postoperative course was uneventful, and the patient was discharged on postoperative day 13 from the initial operation and postoperative day 5 from packing removal.

中文翻译：

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Mass前大出血的治疗策略

案例摘要： 

一名84岁的男性患者主诉便秘和直肠出血6个月。结肠镜检查和刚性乙状结肠镜检查显示直肠上后部肿块（距肛门13厘米）。组织病理学证实为中分化腺癌。胸部，腹部和骨盆的CT扫描以及骨盆核磁共振成像显示，直肠中段癌cT3N0M0具有明确的预测周缘。该患者接受了肿瘤特异性全直肠系膜切除和结肠造口术的前切除术。在直肠后解剖期间，扩张的脆弱的曲张pre静脉曲张受损，并观察到严重的出血。最初的骨盆包装以及骨蜡和夹子无效。结扎内动脉，最终成功进行额外的包装，止血。