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The lower gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
An enterocele is a herniation between the vagina and rectum that is generally filled with abdominal contents, most often small bowel (Figure 3.5). The clinical significance of enteroceles is unclear but, in some, it may contribute to obstructed defaecation because of compression of the rectum.
Fecal Incontinence, Physical Examination
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
An enterocele is a herniation of the lining of the pelvic peritoneum into the rectovaginal septum. Upon straining, the hernia sac will usually fill with small intestine. An enterocele is diagnosed by bidigital rectal and vaginal examination or by defecography. All patients with enterocele should be suspected of having intussusception or prolapse of the rectum.
Rectal Prolapse and Associated Pelvic Organ Prolapse Syndromes
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
André D’Hoore, Oliver M. Jones
An enterocele is a vaginal bulge in which the peritoneal sac containing a portion of the small bowel extends into the rectovaginal space between the posterior surface of the vagina and the anterior surface of the rectum. A sigmoidocele describes the same phenomenon except the main content of the sac is colon. These are also covered briefly in the Gynaecology for the Colorectal Surgeon section (Chapter 1).
Outcomes of a fixed skeletonised mini mesh implant for pelvic organ prolapse repair with uterine preservation
Published in Journal of Obstetrics and Gynaecology, 2022
Omri Levor, Menahem Neuman, Jacob Bornstein
All the procedures included reinforced apical support using mini mesh implants, with preservation of the uterus and anti-incontinence surgery and colporrhaphy were performed when indicated. An hour before the surgery, the patients were given one g Monocef (Cefonicid, Beecham Healthcare) intravenously and their vaginal area was rinsed with iodine antiseptic vaginal wash, and the patients were put under general anaesthesia. Urinary bladder catheterisation and diagnostic cystoscopy were not routinely performed. The mini mesh implant used was Seratom PA MR MN (Serag Wiessner, Naila, Germany) made of partially absorbable materials, resulting in a lightweight mesh that loses 50% of its mass in six months. The mesh contains two pairs of ten-mm-wide arms for paravesical or pararectal and sacrospinous ligament (SSL) fixation. One pair of arms was fixed on the distal anterior or posterior part of the vagina and on either side of the proximal urethra or rectum, whereas the other pair was fixed to the SSL with SERAPRO® RSD-Ney (Serag Wiessner), a reusable-suturing device designed to facilitate suture placement through the SSL. It requires a relatively narrow transvaginal dissection towards SSL, thus, potentially reducing dissection-related complications, and the use of a small mesh implant lessens the invasiveness of the procedure. The mesh was inserted through an anterior vaginal wall incision to correct anterior or posterior compartment and apical prolapse. After the dissection was performed and the cystocele or enterocele was repaired, the skeletonised mini mesh implant provided enough support to the compartment prolapse.
Case report of a peritoneal inclusion cyst presenting as pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2020
Gnankang Sarah Napoe, Charles R. Rardin
In the operating room, dense pelvic adhesions were noted. Her right ovary appeared cystic with a large cystic lesion filling the pelvis that did not appear to involve the bowel. A gynaecological oncologist was consulted and they felt that the ovary was unlikely to be malignant. They recommended post-operative imaging to fully characterise the lesion. After extensive lysis of adhesions, the vaginal cuff still could not be reached so the decision was made to proceed with vaginal prolapse repair. Posterior entry was achieved into the rectovaginal space revealing a bulge. A dissection revealed a cystic lesion, which drained 1500 mL of straw-coloured fluid, consistent with lesion seen abdominally. The distal cyst wall was resected after closure and on pathology was consistent with mesothelial line fibroadipose tissue or PIC. After completion of the enterocele repair, the vaginal apex was well supported. The rectovaginal fascia was plicated and the vaginal epithelium was reapproximated leading to excellent support of all vaginal compartments.
Staged repair of concomitant rectovaginal fistula and pelvic organ prolapse after removal of a neglected pessary
Published in Baylor University Medical Center Proceedings, 2020
Stacy Mathews, Shaked Laks, Carola LaFollette, T. Ignacio Montoya, Pedro A. Maldonado
There is a paucity of information to guide treatment with colpopexy using mesh at the time of a rectovaginal fistula repair. Sacrocolpopexy with mesh implant can raise concerns for mesh erosion through the rectum if the mesh is placed adjacent to the fistula repair. Instead, we propose that colpopexy with mesh be considered as a delayed repair after the fistula repair has healed, or as a concomitant repair with minimal posterior vaginal wall mesh application and a margin away from the fistula repair. In elderly patients with procidentia or advanced posthysterectomy prolapse who are no longer sexually active, colpocleisis can be considered either at the time of fistula repair or after the fistula has healed.6 Isolated posterior vaginal wall prolapse can pose more of a challenge. Delayed prolapse repair such as posterior colporrhaphy with or without enterocele repair or apical suspension should be entertained to allow for adequate fistula healing.