Enterocele
| Enterocele | |
|---|---|
| Other names | Enterocoele |
| Specialty | Gynecology |
An enterocele is a tion of peritoneum and small intestine through the pelvic floor, between the rectum and the vagina (in females).[1][2]
It is a protrusion of the small intestines and peritoneum into the vaginal canal.[3] It may be treated transvaginally[4] or by laparoscopy.
It has been suggested that the terms enterocele and sigmoidocele are inaccurate, since hernias are usually named according to location and not according to contents.[5] However, the terms are in widespread use.[5] As such, enterocele, peritoneocele, sigmoidocele, and omentocele could be considered as types of cul-de-sac hernia.[6][2]
Classification
- Posterior enterocele (develops in the rectovaginal space, also termed the pouch of Douglas or the cul-de-sac).[1]
- Anterior enterocele (develops in the vesicovaginal space).[1]
Anterior enterocele is rare.[1] It may occur after cystectomy or hysterectomy.[1] In these cases, the anterior wall of the vagina is weakened or missing due to loss of support from the bladder.[1]
On defecography, enterocele is defined as the presence of small bowel between the rectum and the vagina.[2] The hernia must reach lower than the upper third of the vagina when the patient is attempting to defecate.[2]
The severity of enterocele can be described with reference to lines drawn on defecography:
- First-degree enterocele: above the pubococcygeal line.[2][note 1]
- Second-degree enterocele: below the pubococcygeal line but above the ischiococcygeal line.[2][note 2]
- Third-degree enterocele: below the ischiococcygeal line.[2]
Another way of classifying the severity of an enterocele (or peritoneocele, omentocele, sigmoidoceles) is according to the distance between the pubococcygeal line and the most inferior (lowest) point of the hernia:
Signs and symptoms
An enterocele may also obstruct the rectum, leading to symptoms of obstructed defecation.[7] Enteroceles can form after treatment for gynecological cancers.[8]
See also
Notes
- ^ The "pubococcygeal line" (PCL) is a reference line which may be drawn on defecography. It extends from the inferior (lower) border of the pubic symphysis to the last coccygeal joint. See Bordeianou et al. 2018.
- ^ The "ischiococcygeal line" is a reference line which may be drawn on defecography. It extends from the inferior (lower) border of the ischium to the last coccygeal joint. See Bordeianou et al. 2018.
References
- ^ a b c d e f g h Okada, Y; Matsubara, E; Nomura, Y; Nemoto, T; Nagatsuka, M; Yoshimura, Y (November 2020). "Anterior enterocele immediately after cystectomy: A case report". The journal of obstetrics and gynaecology research. 46 (11): 2446–2449. doi:10.1111/jog.14437. PMID 32820567.
- ^ a b c d e f g h i j Bordeianou LG, Carmichael JC, Paquette IM, Wexner S, Hull TL, Bernstein M, et al. (April 2018). "Consensus Statement of Definitions for Anorectal Physiology Testing and Pelvic Floor Terminology (Revised)" (PDF). Diseases of the Colon and Rectum. 61 (4): 421–427. doi:10.1097/DCR.0000000000001070. PMID 29521821.
- ^ Merck Manuals > Cystoceles, Urethroceles, Enteroceles, and Rectoceles Last full review/revision December 2008 by S. Gene McNeeley
- ^ Vaginal Repair of Enterocele Archived 2018-04-23 at the Wayback Machine By Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D. Retrieved Dec 2010
- ^ a b Wexner, SD; Stollman, N, eds. (2016). Diseases of the Colon. CRC Press. pp. 124, 125. ISBN 9780429163791.
- ^ Azadi, A; Cornella, JL; Dwyer, PL; Lane, FL (1 September 2022). Ostergard’s Textbook of Urogynecology: Female Pelvic Medicine & Reconstructive Surgery. Lippincott Williams & Wilkins. pp. 212, 213. ISBN 978-1-9751-6235-1.
- ^ Zbar, Andrew P., ed. (2010). Coloproctology. Springer Specialist Surgery Series. Dordrecht Heidelberg: Springer. ISBN 978-1-84882-755-4.
- ^ Ramaseshan, Aparna S.; Felton, Jessica; Roque, Dana; Rao, Gautam; Shipper, Andrea G.; Sanses, Tatiana V. D. (2017-09-19). "Pelvic floor disorders in women with gynecologic malignancies: a systematic review". International Urogynecology Journal. 29 (4): 459–476. doi:10.1007/s00192-017-3467-4. ISSN 0937-3462. PMC 7329191. PMID 28929201.
External links
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