Pudendal enterocele with bladder involvement

A 72-year-old diabetic women presented with a large left labial mass following multiple prior vaginal surgeries to correct vaginal vault prolapse, including two failed right-sided sacrospinalis fixation procedures and a near total colpocleisis. After failure of conservative management, a translabial repair of this pudendal hernia containing bladder was performed. Return of the labial mass 9 months later prompted a more extensive abdominal approach. To close the defect in the urogenital diaphragm and prevent its recurrence, an absorbable mesh was used. Then, to prevent enterocele recurrence, vaginal vault suspension to the sacral promontory and closure of the Douglas pouch were performed. A review of the literature is presented, with an analysis of risk factors and corrective surgical techniques.