title: Central perineal hernia mimicking rectocele: a case report.
abstract: BACKGROUND
  A perineal hernia is a very rare clinical finding. Three forms are distinguished: anterior, posterior, and central. Diagnosis of the last one is difficult, and sometimes, it is falsely named a posterior rectocele.
  
  
  OBJECTIVE
  This work presents a successfully treated case of central perineal hernia and makes a brief summary of existent literature on the problem.
  
  
  METHODS
  We report of a 67-year-old female patient with a symptomatic central pelvic floor hernia. After radiological confirmation of the diagnosis, a transperitoneal approach was chosen to reposition the protruded segment of the small bowel. The hernial orifice was closed by extraperitoneal implantation of a polypropylene mesh.
  
  
  CONCLUSIONS
  In the present case, the use of a laparoscopic technique seemed unsuitable due to the extension of the findings. For the repair of perineal hernia, we followed the principles of the "tension-free" concept. If there are no signs of a pelvic floor infection and if the mesh can be implanted totally extraperitoneally, we recommend the use of nonabsorbable alloplastic material (polypropylene) for reinforcement of the pelvic floor as a suitable technique for the repair of large perineal hernias.
authors.affiliation: Department of Surgery, St. Josef Hospital-University Medical Center, Ruhr University Bochum, Bochum, Germany. d.weyhe@elis-stiftung.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Weyhe
authors.forename: Bruno
authors.initials: B
authors.lastname: Geier
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Claudia
authors.initials: C
authors.lastname: Steinfort
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Volker
authors.initials: V
authors.lastname: Zumtobel
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006547:Hernia / Q000175:diagnosis*; D006801:Humans; D017773:Pelvic Floor; D010502:Perineum / Q000473:pathology*; D020047:Rectocele / Q000175:diagnosis*; D013526:Surgical Mesh