Central perineal hernia mimicking rectocele: a case report.
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.
Weyhe
Dirk
D
Department of Surgery, St. Josef Hospital-University Medical Center, Ruhr University Bochum, Bochum, Germany. d.weyhe@elis-stiftung.de
Geier
Bruno
B
Belyaev
Orlin
O
Steinfort
Claudia
C
Uhl
Waldemar
W
Zumtobel
Volker
V
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