ABSTRACT
CHALLENGING CASE You are operating on 64-year-old man with a locally advanced rectal cancer that has been treated with neoadjuvant chemoradiation. The mass is large, the dissection is difficult and the tissue is edematous and friable. As you are dissecting along the right pelvic sidewall your assistant adjusts the retractor and there is an immediate, brisk rush of blood into the field. You attempt to pack the area but the blood soaks the lap immediately. Your patient is bleeding. You also note significant edema and are already concerned about closing the abdomen.
