Enterocele: what is the clinical implication?

Because of the rarity of diagnosis, the clinical implication of enterocele remains unclear. This study was designed to clarify the characteristic symptoms and the role of surgical treatment for enterocele.

We reviewed a defecography database prospectively maintained from 1998 to 2004. Defecography was performed with oral barium to opacify the small bowel in all patients. Enterocele was defined as the small bowel falling down beyond the level of the vaginal vault practically, it was <3 cm from the anorectal angle in the lateral view. Patients' clinical information was collected using a questionnaire. Patients with intractable symptoms underwent surgical repair.

Among 912 patients on defecography, 104 patients (11 percent) revealed an enterocele (18 males mean age, 63 (range, 21-86) years). Concomitant abnormal findings, such as perineal descent, rectocele, and rectal intussusception, were encountered in 79 patients (76 percent). Only 25 patients (24 percent) had isolated enteroceles. Characteristic symptoms were difficulty emptying (61 patients), postevacuation discomfort (54 patients), and pelvic pain (28 patients). Eleven patients (10 females) underwent Douglas' pouch repair. Three of the 11 patients reported complete resolution of pelvic pain. The remaining eight patients experienced reduced symptoms, mainly resolution of pelvic heaviness, but still had difficulty emptying or postevacuation discomfort.

This study suggests that the characteristic symptoms of enterocele are: difficulty emptying, postevacuation discomfort, and pelvic pain or heaviness. Selected patients with pelvic pain rather than obstructed defecatory symptoms might benefit from surgical repair.