An enterocele is a herniation of a peritoneum-lined sac containing small intestine through the pelvic floor, between the rectum and the vagina (in females).
[5] It has been suggested that the terms enterocele and sigmoidocele are inaccurate, since hernias are usually named according to location and not according to contents.
[2] In these cases, the anterior wall of the vagina is weakened or missing due to loss of support from the bladder.
[2] On defecography, enterocele is defined as the presence of small bowel between the rectum and the vagina.
[1][4] If an enterocele is present, the hernia sac will come down into the rectovaginal space, between the rectum and the vagina, when the patient strains.
[4] On defecography enterocele is more evident after defecation, once the rectum / bladder are empty and more space becomes available in the pelvic cavity.
[5] Simultaneous dynamic proctography and peritoneography (injection of contrast into peritoneum) is effective at detection of enteroceles.
However, it is difficult to inject contrast agent into the peritoneal cavity and there is a risk of contamination of the peritoneum.
[1] Dynamic pelvic magnetic resonance imaging is accurate and can detect enterocele, but it is not widely available.
[14] Hysterectomy or urethropexy increase the rectovaginal space and reduce support from adjacent organs.
[1] Surgical treatment may be considered if the hernia is substantial and is suspected to be the cause of obstructed defecation.