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Female enterocele — Clinical Guidelines

Overview

Enterocele, a form of pelvic organ prolapse, involves the herniation of peritoneum or small bowel into the vaginal canal, often associated with apical prolapse such as uterine or vaginal vault descent. 4

Diagnosis

Clinical assessment through pelvic examination is essential for diagnosis.

Imaging studies like MRI or ultrasound may be used to confirm the presence and extent of enterocele 4.

No specific grading system universally accepted; clinical severity often guides management decisions 4.

Management

Surgical intervention is often required for symptomatic enterocele, including vaginal or laparoscopic approaches to repair apical prolapse and enterocele 4.

Conservative management may include pelvic floor therapy for mild cases, though evidence is limited 4.

Use of mesh in surgical repairs can be considered to enhance durability, though associated risks must be weighed 4.

Special Populations

Pregnancy: Limited data; surgical intervention typically deferred until postpartum stabilization 4.

Elderly: Considerations for comorbidities and surgical risk stratification are crucial 4.

Comorbidities: Presence of other pelvic floor disorders may influence surgical approach and complexity 4.

Key Recommendations

Surgical repair is recommended for symptomatic enterocele to alleviate symptoms and prevent complications (Evidence: Moderate 4).

Patient-specific factors including age, comorbidities, and surgical history should guide the choice between vaginal versus laparoscopic repair (Evidence: Expert opinion 4).

Incorporate pelvic floor therapy as adjunctive management for mild cases to improve outcomes (Evidence: Weak 4).

References

1 Shvartsman K, Abuhamdeh SA, Dong T, Lutgendorf M, Peterson L, Ulfers A et al.. Are Age, Sex, or Race and Ethnicity Associated With Performance on the OBGYN NBME Exam and Clerkship?. Journal of surgical education 2025. link 2 Choueka D, Tabakin AL, Shalom DF. ChatGPT in Urogynecology Research: Novel or Not?. Urogynecology (Philadelphia, Pa.) 2024. link 3 Meister T, Foessleitner P, Breuer G, Winder FM, Favero M, Friemann M et al.. The impact of gender on the self-confidence of practical and surgical skills among OBGYN residents: a trinational survey. Archives of gynecology and obstetrics 2024. link 4 Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z et al.. Surgery for women with apical vaginal prolapse. The Cochrane database of systematic reviews 2023. link 5 Sappenfield EC, Tunitsky-Bitton E. Beef Tongue Surgical Simulation Model for Posterior Vaginal Repair. Obstetrics and gynecology 2021. link 6 Winkelman WD, Jaresova A, Hacker MR, Richardson ML. Salary Disparities in Academic Urogynecology: Despite Increased Transparency, Men Still Earn More Than Women. Southern medical journal 2020. link 7 Mathew S, Samant N, Cooksey C, Ramm O. Knowledge, Attitudes, and Perceptions About Medicolegal Education: A Survey of OB/GYN Residents. The Permanente journal 2020. link 8 Biggs MA, Kimport K, Mays A, Kaller S, Berglas NF. Young Women's Perspectives About the Contraceptive Counseling Received During Their Emergency Contraception Visit. Women's health issues : official publication of the Jacobs Institute of Women's Health 2019. link 9 Hill N, Gupta A, Zakaryan A, Morey R. The success of 6-hour hospital discharge on patients having vaginal repair operations using a new conscious sedation technique. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2011. link

Female enterocele