The Surgical Correction of Pulsion Enterocoele

Abstract

This variety, the least common must be assumed due to a persistent or recurrent narrow-necked sac following prolapse repair. Many believe a congenital defect of the cul-de-sac or rectovaginal septum is the likely starting point. At a variable time following primary reparative surgery, the patient will notice vague feelings of vaginal pressure, a sensation of something descending the vagina, but usually there are no other symptoms. Examination demonstrates the defect with typical physical signs of enterocoele. It is a slender, often pear-shaped protrusion through the upper posterior vaginal wall, with a narrow neck tapering to a much wider fundus. Until late in its development, marked change in the overlying vaginal epithelium is unusual. Management depends upon size — the larger always need surgical correction, but smaller defects may be reviewed periodically. Surgical correction is straightforward, since the underlying anatomical defects always present with larger examples, are absent. Posterior colpoperineorrhaphy is performed, the posterior vaginal wall being opened either by midline incision, or wedge excision of redundant vaginal epithelium, depending on circumstances. Dissection proceeds to the vaginal vault when the hernial sac is identified and freed from the rectum.