Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan.
J Obstet Gynaecol Res. 2020 Nov;46(11):2446-2449. doi: 10.1111/jog.14437. Epub 2020 Aug 20.
An enterocele is a peritoneal herniation through or into the vagina, typically as a posterior enterocele, which develops in the rectovaginal space (pouch of Douglas or cul-de-sac). An anterior enterocele in the vesicovaginal space is a rare condition, but a possible complication after cystectomy or hysterectomy. Herein, we report a rare case of anterior enterocele after cystectomy, which required semi-urgent intervention. The patient was a 78-year-old woman (gravida 2, para 2) who underwent laparoscopic radical cystectomy for bladder carcinoma 3 months earlier. Vaginal examination showed a large stage-3 anterior enterocele without the covering vaginal wall. A transvaginal surgery was performed to repair the vagina. Mesh and Martius flaps were needed to repair the vaginal defect. In conclusion, an anterior enterocele must be suspected when pelvic organ prolapse occurs after cystectomy, and surgical repair should be performed as soon as possible because an enterocele that lacks vaginal wall covering is at high risk of rupture.
肠膨出是指腹膜通过或进入阴道的疝出，通常为直肠阴道隔（道格拉斯窝或直肠子宫陷凹）的后肠膨出。膀胱阴道空间中的前肠膨出是一种罕见的情况，但在膀胱切除术或子宫切除术之后可能是一种并发症。在此，我们报告一例膀胱切除术后罕见的前肠膨出病例，该病例需要半紧急干预。患者为 78 岁女性（孕 2 产 2），3 个月前因膀胱癌行腹腔镜根治性膀胱切除术。阴道检查显示大型 III 期前肠膨出，无阴道壁覆盖。行阴道修补术。需要使用网片和马蒂厄（Martius）皮瓣来修复阴道缺陷。总之，在膀胱切除术后发生盆腔器官脱垂时应怀疑前肠膨出，应尽快进行手术修复，因为缺乏阴道壁覆盖的肠膨出有很高的破裂风险。
