Enterocele Repair

Abstract

An enterocele is a herniation through the vaginal support structures, of a peritoneum-lined sac containing small bowel or omentum. Most commonly, this herniation occurs posteriorly between the rectum and vagina, but theoretically, it may present anywhere along the vaginal axis. The occurrence of an enterocele in isolation is unusual, except in patients who have undergone previous hysterectomy, bladder neck surgery or pelvic floor repair. More often, it is a component of general pelvic floor relaxation with accompanying rectocele, cystocele, or uterine or vaginal vault prolapse. The diagnosis of enterocele in these circumstances can sometimes be difficult. A combined rectovaginal examination with the patient bearing down may detect a palpable loop of bowel between thumb and index finger leading to the diagnosis; however, this is not always the case and occasionally an enterocele is only discovered intraoperatively. Ultrasound assessment of the pelvic floor increases the diagnostic accuracy of prolapse, allowing proper planning of corrective surgery.