Abstract
PURPOSE: Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum. This hernial sac contains either sigmoid colon or small bowel. It is well known that enteroceles are associated with symptoms of pelvic discomfort. It is unclear whether enteroceles contribute to evacuation difficulties. Controversies also exist regarding their treatment of choice. The aim of the present prospective study was to evaluate the impact of obliteration of the pelvic inlet on evacuation difficulties and on symptoms of pelvic discomfort. METHODS: From October 1994 to August 1996 20 females (median age, 53; range, 41–73 years) with symptomatic enterocele diagnosed on evacuation proctography underwent obliteration of the pelvic inlet with a nonabsorbable Mersilene® mesh. All patients presented with pelvic discomfort, characterized by feelings of prolapse (n=20), pelvic pressure (n=16), lower abdominal pain (n=13), and false urge to defecate (n=15). Symptoms of obstructed defecation were noted in 15 patients. Six months after repair, evacuation proctography with opacification of the small bowel and the vagina was repeated. RESULTS: The median duration of follow-up was 25 (range, 10–34) months. A persistent or recurrent enterocele was observed in none of the patients. All symptoms of pelvic discomfort disappeared except feelings of a false urge to defectate, which persisted in 27 percent of cases. Symptoms of obstructed defecation persisted in all patients with evacuation difficulties. CONCLUSIONS: In patients with pelvic discomfort enterocele should be considered as a possible causative factor. It is unlikely that this abnormality contributes to the problem of obstructed defecation. In patients with a symptomatic enterocele, obliteration of the pelvic inlet with a Mersilene® mesh is an adequate treatment.
Similar content being viewed by others
References
Holley RL. Enterocele: a review. Obstet Gynecol Surv 1994;49:284–93.
Ranney B. Enterocele, vaginal prolapse, pelvic hernia: recognition and treatment. Am J Obstet Gynecol 1981;140:53–61.
Freimanis MG, Wald A, Caruana B, Bauman DH. Evacuation proctography in normal volunteers. Invest Radiol 1991;26:581–5.
Shorvon PJ, Mc Hag S, Diamant, NE, Somers, Steverman GW. Defecography in normal healthy volunteers. Results and implications. Gut 1989;30:1737–49.
Halligan S, Bartram C, Hall C, Wingate J. Enterocele revealed by simultaneous evacuation proctography and peritoneography: does the defecation block exist? Am J Roentgenol 1996;167:461–6.
Halligan S, Bartram C. Evacuation proctography combined with positive contrast peritoneography to demonstrate pelvic floor hernias. Abdom Imaging 1995;20:442–5.
Ekberg O, Nylander G, Fork FT. Defecography. Radiology 1985;155:45–8.
Choi DL, Ekberg O. Functional analysis of anorectal junction: defecography. Rofo Fortschr Geb Rontgenstr Nuklearmed 1988;148:50–3.
Nichols DH. Types of enterocele and principles underlying choice of operation for repair. Obstet Gynecol 1972;40:257–63.
Read CD. Enterocele. Am J Obstet Gynecol 1951;62:743–57.
Burch JC. Urethrovaginal fixation to Cooper's ligament for correlation of stress incontinence, cystocele and prolapse. Am J Obstet Gynecol 1961;81:281–90.
Barham K, Collopy BT. Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. Aust N Z J Obstet Gynaecol 1993;33:300–3.
Symmonds RE, Williams TJ, Lee RA, Webb MJ. Posthysterectomy enterocele and vaginal vault prolapse. Am J Obstet Gynecol 1981;140:852–9.
Kauppila O, Punnonen R, Teisala K. Prolapse of the vagina after hysterectomy. Surg Gynecol Obstet 1985;161:9–11.
De Lancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 1992;166:1717–24.
Holland JB. Enterocele and prolapse of the vaginal vault. Clin Obstet Gynecol 1972;40:257–63.
Mellgren A, Johansson C, Dolk A,et al. Enterocele demonstrated by defaecography is associated with other pelvic floor disorders. Int J Colorectal Dis 1994;9:121–4.
Walden L. Defecation block in cases of deep rectovaginal pouch. Acta Chir Scand 1952;165:120–2.
Jorge JM, Yang Y-K, Wexner SD. Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum 1994;37:1112–7.
Mellgren A, Dolk A, Johansson C, Bremmer S, Anzén B, Holmström B. Enterocele is correctable using the Ripstein rectopexy. Dis Colon Rectum 1994;37:800–4.
Moschcowitz AV. The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet 1912;15:7–21.
Waters EG. Culdoplastic technique for prevention and correction of vaginal vault prolapse and enterocele. Am J Obstet Gynecol 1961;81:291–7.
Rust JA, Botte JM, Howlett RJ. Prolapse of the vaginal vault. Improved techniques for management of the abdominal approach or vaginal vault approach. Am J Obstet Gynecol 1976;125:768–76.
Marion G. Cited by Read CD. Enterocele. Am J Obstet Gynecol 1951;62:743–57.
Nichols DH. Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol 1982;142:901–4.
Peters WA, Christenson ML. Fixation of the vaginal apex to the coccygeus fascia during repair of vaginal vault eversion with enterocele. Am J Obstet Gynecol 1995;172:1894–900.
Ginai AZ. Technical report: evacuation proctography (defecography) a new seat and method of fixation. Clin Radiol 1990;42:214–6.
Johansson C, Ihre T, Ahlbäck SO. Disturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia). Dis Colon Rectum 1985;28:920–4.
Kelvin FM, Maglinte DD, Hornback JA, Benson JT. Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 1992;184:547–55.
Maloney JC, Dunton CJ, Smith K. Repair of vaginal vault prolapse with abdominal sacropexy. J Reprod Med 1990;35:1–4.
Virtanen H, Hirvonen T, Makinen J, Kiilholma P. Outcome of thirty patients who underwent repair of posthysterectomy prolapse of the vaginal vault with abdominal sacral colpopexy. J Am Coll Surg 1994;178:283–7.
Author information
Authors and Affiliations
Additional information
Read at the XVIIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Malmö, Sweden, June 7 to 11, 1998.
About this article
Cite this article
Gosselink, M.J., van Dam, J.H., Huisman, W.M. et al. Treatment of enterocele by obliteration of the pelvic inlet. Dis Colon Rectum 42, 940–944 (1999). https://doi.org/10.1007/BF02237106
Issue Date:
DOI: https://doi.org/10.1007/BF02237106