Enterocele


Introduction

Enterocele occurs when the intestinal loops descend into the lower part of the pelvis, causing a compression on the rectum and preventing defecation. This pathology, typical in women, occurs when the pelvic floor descends significantly due to laxity of the tissues or physiological aging, and especially when there has been a previous hysterectomy. The lack of uterus leaves a space between the urinary bladder and the rectum that is occupied by the loops of the small intestine or sigmoid colon (if redundant). The absence of uterus, removed in a previous gynaecological surgery, both vaginally and abdominally, is a factor that predisposes the small intestine or part of the colon to descend into the deepest part of the pelvis and on the rectum.

The result of this “occupation” is an important difficulty to have bowel movements and be resistant to laxatives; it is also associated with pain in the lower abdomen, a constant heavy feeling and abdominal distension.

This disorder can often coexist with other benign pelvic soil conditions such as internal rectal prolapsed or rectocele.


Treatment

Laparoscopic ventral colpo-sacropexy surgery is the treatment of choice for this pathology. It consists of repositioning the intestine outside the pelvis, opening up the peritoneal tissue that forms the bottom of the pelvis, removing the rectum from the vagina and suturing them to a mesh that will be attached to the sacral bone so that they can remain attached and stretched upwards. Subsequently, the open peritoneal tissue is sutured to form a new pelvic background but in a higher position far from the underlying rectum.


Benefits

Surgery helps the loops of the intestine to stop leaning and pressing on the rectum by removing the obstruction of stool in its final stretch. All symptoms secondary to the obstructive problem will recede: inability to defecate, pain, abdominal swelling, irritability or depression, which may have been caused by the intestinal problem.



Expert opinion

Dr. Domenico Fraccalvieri
Dr.  Domenico Fraccalvieri

Most patients who are unable to defecate normally believe that they have a common, although severe, constipation and use or abuse of laxatives. When laxatives do not produce the expected effect, it is necessary the evaluation of a Coloproctologist who is an expert in pathologies of the pelvic floor, so that an obstructive and non-functional defecatory problem can be ruled out, and solved, if needed.

If diagnosed, the enterocele can be successfully treated with laparoscopic surgery as long as it is carried out by an experienced surgeon in benign pelvic disease and laparoscopic surgery. It will have a prompt postoperative recovery, not really painful, and with low risk of complications;.

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