Most of the anterior sacral vein hemorrhage is due to local anatomical unclear and avulsion of the anterior sacral vein during surgery. Therefore, the separation of the posterior rectal wall should always be performed in the rectal mesentery in front of the anterior sacral fascia, and the separation should be performed under direct vision to ensure the integrity of the anterior sacral fascia in order to avoid the occurrence of anterior sacral hemorrhage. Rectal cancer invading the whole layer and located in the anterior sacral area or even invading the sacrum is another main reason for not being able to enter the correct anatomical gap for anterior sacral bleeding. Although the incidence of anterior sacral hemorrhage during rectal cancer surgery is not very high, patients’ lives are endangered by massive and rapid blood loss. The key to avoiding this critical situation is correct access to the anatomical level during surgery and gentle surgical operation. The site of bleeding should be clarified as soon as possible after hemorrhage occurs. Emergency treatment methods include gauze compression, suture ligation, special steel staples, bone wax, internal iliac artery ligation, electrocautery and medical glue, etc., along with rapid transfusion of blood for anti-shock treatment. In recent years, domestic and foreign literature reported the use of autologous rectus abdominis muscle electrocoagulation welded to the anterior sacral bleeding point, which also played a clear hemostatic effect.