Enterocele: is there a histologic defect?
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.


CONCLUSIONS
Women with enteroceles have a well-defined vaginal muscularis between the peritoneum and vaginal epithelium.
Tulikangas
P K
PK
Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Walters
M D
MD
Brainard
J A
JA
Weber
A M
AM
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011859:Radiography; D014596:Uterine Prolapse / Q000000981:diagnostic imaging / Q000473:pathology*; D014621:Vagina / Q000473:pathology*