Massive presacral hemorrhage following rectal mobilization for benign or malignant conditions is an uncommon complication but one that is alarming and often difficult to treat. A variety of methods of hemostasis have been described, all with mixed degrees of success. We have used a segment of free rectus abdominis muscle to provide tamponade to the presacral bleeding point in two patients with severe bleeding. The technique was successful and may be considered in cases of problematic hemorrhage when other techniques have failed or inapplicable.