and the anterior rectal wall, to a distance of >2 cm or inferior to the proximal one third of the vagina (Fig. 9.4). The peritoneocele may intermittently contain small bowel contents, resulting in an enterocele (Fig. 9.5). On defecography without peritoneography, a peritoneocele is suggested by an unexplained increase in the recto-vaginal (or rectogenital) space during straining. Similarly, an enterocele is suggested by air-filled small-bowel loops within that space.
Increasing use of defecography has led to more frequent diagnosis of enteroceles; their prevalence is now estimated at 18% to 37%, and upward of 55% of patients with an enterocele have other concomitant pelvic floor disorders.29 However, little is known of the actual impact
enteroceles have on rectal emptying. Halligan and colleagues30 prospectively studied 50 consecutive patients with constipation, and compared their results with 31 controls undergoing peritoneography for groin pain. Although a majority of constipated patients (77% versus 10% in the control group) had deep rectogenital pouches, only 58% filled with small-bowel contents during the study. Moreover, those patients with an enterocele evacuated more rapidly and completely than did the constipated patients with or without a deep pouch.
When is the diagnosis of an enterocele relevant? Among the 11% of U.S. women who will have a pelvic floor repair by age 80 years,31 pre-operative identification and concomitant repair of a peritoneocele or enterocele may help to prevent persistent symptoms or early recurrence of obstruction.22 Nonetheless, among minimally symptomatic or asymptomatic patients, or among those in whom a repair is not otherwise warranted, the prudent surgeon must not over-construe the importance of an incidentally identified enterocele.
Was this article helpful?
Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.