Treatment bf enterocele by obliteration of the pelvic inlet

PURPOSE: Enterocele is defined as a herniation of the peritoneal sac betwee n the vagina and the rectum. This hernial sac contains either sigmoid colon or small bowel. It is well known that enteroceles are associated with symp toms of pelvic discomfort. It is unclear whether enteroceles contribute to evacuation difficulties. Controversies also exist regarding their treatment of choice. The aim of the present prospective study was to evaluate the im pact of obliteration of the pelvic inlet on evacuation difficulties and on symptoms of pelvic discomfort. METHODS: From October 1994 to August 1996 20 females (median age, 53; range, 41-73 years) with symptomatic enterocele d iagnosed on evacuation proctography underwent obliteration of the pelvic in let with a nonabsorbable Mersilene(R) mesh. All patients presented with pel vic discomfort, characterized by feelings of prolapse (n = 20), pelvic pres sure (n = 16), lower abdominal pain (n = 13), and false urge to defecate (n = 15). Symptoms of obstructed defecation were noted in 15 patients. Six mo nths after repair, evacuation proctography with opacification of the small bowel and the vagina was repeated. RESULTS: The median duration of follow-u p was 25 (range, 10-34) months. A persistent or recurrent enterocele was ob served in none of the patients. All symptoms of pelvic discomfort disappear ed except feelings of a false urge to defecate, which persisted in 27 perce nt of cases. Symptoms of obstructed defecation persisted in all patients wi th evacuation difficulties. CONCLUSIONS: In patients with pelvic discomfort enterocele should be considered as a possible causative factor. It is unli kely that this abnormality contributes to the problem of obstructed defecat ion. In patients with a symptomatic enterocele, obliteration of the pelvic inlet with a Mersilene(R) mesh is an adequate treatment.