BackgroundHemorrhage is a known complication of presacral surgery. This is the first gynecologic case of presacral hemorrhage that was controlled with indirect coagulation through a muscle fragment.CaseA 29-year-old woman with central long-term pelvic pain underwent a presacral neurectomy. Presacral bleeding was encountered during dissection of the hypogastric plexus. Conventional hemostatic methods failed to control presacral hemorrhage. Hemostasis was finally achieved using indirect coagulation through a muscle fragment.ConclusionIndirect coagulation through a muscle fragment may be useful when conventional presacral hemostatic methods fail or when sterile thumbtacks or the applicator is not available.