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Enterocele: Is There a Histologic Defect?

From the Department of Obstetrics and Gynecology and Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio; and Department of Obstetrics and Gynecology, Magee-Women’s Hospital, Pittsburgh, Pennsylvania.

Address reprint requests to: Mark D. Walters, MD, Head, Section of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology/A81, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195; E-mail: walterm{at}ccf.org.

OBJECTIVE: To examine the histology of the vaginal wall in women with an enterocele confirmed by physical examination, cystoproctography, and intraoperative exploration.

METHODS: Thirteen women with posthysterectomy apical and posterior wall prolapse were evaluated with a detailed physical examination, cystoproctography, and intraoperative exploration. All women had enterocele repair. A specimen of full thickness vaginal wall from the leading edge of the enterocele was excised and examined histologically. The histology of these patients was compared with the histology of two comparison groups, five women undergoing hysterectomy without prolapse and 13 women undergoing radical hysterectomy.

RESULTS: One woman with an enterocele repaired intraoperatively did not have an enterocele by cystoproctography. One woman with an enterocele repaired intraoperatively did not have an enterocele detected by physical examination. All women with an enterocele repaired had an intact vaginal wall muscularis. No woman had vaginal wall epithelium in direct contact with the peritoneum. The average vaginal wall muscularis thickness in women with enteroceles was 3.5 ± 1.4 mm, in women with no prolapse 3.2 ± 0.8 mm, and in women undergoing radical hysterectomy 2.8 ± 0.9 mm.

CONCLUSION: Women with enteroceles have a well-defined vaginal muscularis between the peritoneum and vaginal epithelium.

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				Y. Hsu, L. Chen, J. O. L. Delancey, and J. A. Ashton-Miller Vaginal Thickness, Cross-Sectional Area, and Perimeter in Women With and Those Without Prolapse Obstet. Gynecol., May 1, 2005; 105(5): 1012 - 1017. [Abstract] [Full Text] [PDF]