Enterocele Repair

  • Katarzyna BochenskaEmail author
  • Kimberly Kenton


An enterocele is a herniation of the pelvic peritoneum and/or small bowel beyond the normal boundaries of the cul-de-sac. Endopelvic fascia supporting the anterior, apical or posterior vagina is deficient, allowing the vagina to prolapse and small bowel to fill the hernia sac. An enterocele classically causes apical and/or posterior vaginal wall prolapse as the small bowel dissects into the rectovaginal space. Anterior and/or posterior vaginal wall prolapse without concomitant apical prolapse is uncommon. Therefore, apical prolapse repair should be included in the majority of enterocele repairs. Outcome studies also show that restoration of the apex corrects nearly half of anterior vaginal wall defects and one-third of posterior defects.


Enterocele Pelvic organ prolapse Apical prolapse Halban Moschowitz 

Supplementary material

Video 12.1

(MP4 238274 kb)


  1. 1.
    Kenton K, Shott S, Brubaker L. Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:336–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Hall AF, Theofrastous JP, Cundiff GW, et al. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996;175:1467–70; discussion 70–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Kelvin FM, Hale DS, Maglinte DD, Patten BJ, Benson JT. Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol. 1999;173:31–7.CrossRefPubMedGoogle Scholar
  5. 5.
    DeLancey JO, Morgan DM, Fenner DE, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109:295–302.CrossRefPubMedGoogle Scholar
  6. 6.
    Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS. Four-contrast defecography: pelvic “floor-oscopy”. Dis Colon Rectum. 1995;38:695–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195:1837–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Guiahi M, Kenton K, Brubaker L. Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1267–70.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Brubaker L, Cundiff G, Fine P, et al. A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods. Control Clin Trials. 2003;24:629–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Lowder JL, Park AJ, Ellison R, et al. The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse. Obstet Gynecol. 2008;111:152–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109:848–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Swift S, Woodman P, O’Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192:795–806.CrossRefPubMedGoogle Scholar
  13. 13.
    Mahajan ST, Elkadry EA, Kenton KS, Shott S, Brubaker L. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol. 2006;194:722–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Elkadry EA, Kenton KS, FitzGerald MP, Shott S, Brubaker L. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189:1551–7; discussion 7–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Bradley MS, Visco AG. Role of salpingectomy at the time of urogynecologic surgery. Curr Opin Obstet Gynecol. 2015;27:385–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Committee on Gynecologic P. Committee opinion no. 620: Salpingectomy for ovarian cancer prevention. Obstet Gynecol. 2015;125:279–81.Google Scholar
  17. 17.
    Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354:1557–66.CrossRefPubMedGoogle Scholar
  19. 19.
    Nichols D, Randall C. Vaginal surgery. 4th ed. Baltimore: Williams & Wilkins; 1996.Google Scholar
  20. 20.
    Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010;4:CD004014.Google Scholar
  21. 21.
    Moschowitz A. The pathogenesis, anatomy, and cure of prolapse of the rectum. Surg Gynecol Obstet. 1912;15:7–21.Google Scholar
  22. 22.
    Halban J. Gynakoligische Operationslehre. Berlin-Vienna: Urban & Schwarzenberg; 1932.Google Scholar
  23. 23.
    Bradley CS, Nygaard IE, Brown MB, et al. Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol. 2007;197:642.e1–8.Google Scholar
  24. 24.
    Buckwalter JA. Should bone, soft-tissue, and joint injuries be treated with rest or activity? J Orthop Res. 1995;13:155–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Buckwalter JA. Activity vs. rest in the treatment of bone, soft tissue and joint injuries. Iowa Orthop J. 1995;15:29–42.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Weir LF, Nygaard IE, Wilken J, Brandt D, Janz KF. Postoperative activity restrictions: any evidence? Obstet Gynecol. 2006;107:305–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Division of Female Pelvic Medicine & Reconstructive Surgery, Departments of Obstetrics & Gynecology and UrologyNorthwestern University Feinberg School of MedicineChicagoUSA

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