Enterocele (Pelvic floor hernia)
Enterocele formation (a true hernia of the pelvic floor), which can be reversed through enterocele repair, usually occurs in women who have had a hysterectomy. Most reconstructive surgeons believe this is, in part, due to the removal of the uterus, however enteroceles can also occur in women that have a rectocele with or without prior hysterectomy. To understand an enterocele repair, one must first understand the anatomy of this defect. An enterocele is defined as peritoneum (skin on the inside of the abdominal cavity) in direct contact with peritoneum vaginal epithelium (skin of the vagina) with no intervening fascia (support structure). Enteroceles typically occur at the top of the vagina where uterus once was (in women with prior hysterectomy) but can also occur at the top of the posterior vaginal wall in conjunction with a rectocele. To repair the enterocele, the supportive structure must be reconstructed. The support structure at the apex of the vagina is the pubocervical fascia (anterior vaginal wall) and the rectovaginal fascia (posterior vaginal wall). The apex of both vaginal walls usually fuses into the uterus. However, in patients where the uterus has been removed through a hysterectomy, sometimes the supportive layers of the anterior and posterior walls have not fused or scarred together, leaving an area lacking support. Therefore a herniation at the apex of vagina allows the peritoneum to come in direct contact with vaginal skin and creates a bulge. This bulge is called an enterocele.