Derick Mussen Preventive Healthcare

EnterocelePeritoneocele

• The Ebook To Cure Multiple Sclerosis
• The Secret to Overcoming Anxiety, Panic And Worry
• Wish you could decide if your having a boy or a girl?

A peritoneocele is a caudal invagination of the peritoneum, between the posterior vaginal wall

Figure 9.3. Rectal intussusception or internal prolapse, increasingly pronounced with straining. Note the initial appearance of an anterior rectocele,fol-lowed by the "teacup" appearance of the middle image.

Figure 9.3. Rectal intussusception or internal prolapse, increasingly pronounced with straining. Note the initial appearance of an anterior rectocele,fol-lowed by the "teacup" appearance of the middle image.

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

Figure 9.4. A peritoneocele extending through the vaginal introitus, seen with combined defecography and peritoneography. V, vagina; R, rectum; P, peritoneocele.

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.