Treatment of Enterocele
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Academic Hospital Brothers of Mercy Munich
Department of General and Abdominal Surgery
Charite University Hospital Berlin
Department of General, Abdominal and Vascular Surgery
University Hospital Ulm
Department of General and Abdominal Surgery
University Hospital Carl Gustav Carus Dresden
Department of Abdominal, Thoracic and Vascular Surgery
University Hospital Marburg UKGM
Department of Abdominal, Thoracic and Vascular Surgery
University Hospital Frankfurt am Main
Department of General and Abdominal Surgery
University Hospital RWTH Aachen
Department of Adult and Pediatric General, Abdominal, Transplant Surgery
University Hospital Jena
Department of General, Abdominal and Vascular Surgery
University Hospital Heidelberg
Department of General, Abdominal and Transplant Surgery
University Hospital Halle (Saale)
Department of General, Abdominal, Vascular and Endocrine Surgery
University Hospital Hamburg-Eppendorf
Department of General, Abdominal and Thoracic Surgery
University Hospital Würzburg
Department of General, Abdominal, Transplant, Vascular and Pediatric Surgery
University Hospital Tuebingen
Department of General, Abdominal, Adult and Pediatric Transplant Surgery
University Hospital Rechts der Isar Munich
Department of Surgery
University Hospital Muenster
Department of General, Abdominal and Transplant Surgery
Enterocele is a prolapse of the small bowel. Small bowel is located between large intestine and stomach and it is responsible for absorption of special minerals and nutritional elements from the food, needed for body. Small intestine also receives the bile from the pancreas, thus taking part in the whole gastrointestinal function. During enterocele small bowel is descended into the lower part of pelvic cavity, creating pressure on the vagina or pelvic floor. It also forms the bulge, which is caused by the falling out of the small bowel from place. Enterocele is predominant in women and can be caused by strenuous childbirth and other possible causes of continuous pressure on the pelvic floor, such as chronic cough, weight lifting, and diseases of the small intestine. Bowel diseases and chronic constipation can also be contributing factors to enterocele. Nonetheless, 45% of all enterocele cases are caused by complicated childbirth. Obesity in some cases and long-term lack of physical exercise also cause enterocele. Women who underwent pelvic surgery, who are long-term smokers or who have disorder of the connective tissue are in the risk group.
- Bulge, which can be felt while standing
- Pulling sensation in the pelvic floor area
- Pain in the small intestine
- Feeling of fullness
- Pain during intercourse
- Problems with menstrual cycle
- Discomfort in the lower back
- Examination of the pelvic floor is best in determining if the patient has enterocele. A patient may be asked to bend in several directions and cross the legs in specific positions to understand if protrusion creates the bulge.
- Ultrasound of the pelvic floor can determine if its walls were affected by the enterocele.
- Implantation of the pessary is a procedure, during which special plastic or silicone device is inserted into vagina in order to support the pelvic muscles and keep the bulge from protruding. Pessary needs to be worn permanently or for a certain period of time. Before the implantation, the right type of pessary is found depending on the size of pelvic floor. Special measurements are done to make it.
- Surgery is performed to repair the prolapse. Incision is made in the abdominal or vaginal area to get access to the protrusion. After that, the prolapse is moved back into place to the small intestine, after which the connective tissue is tightened to prevent recurrence of the prolapse. In some cases synthetic mesh is also inserted, if there is high risk that muscles will be weakened again and they need additional support.
Overall, in 80% the recurrence of the prolapse does not happen again and surgery has good results.