Enterocele with Risk of Intestinal Incarceration: A Case Report

Purpose: To describe the diagnosis and management of enterocele with high risk of bowel ischemia in patients with pelvic organ prolapse. Methods: We describe the clinical case of an 81-year-old patient, hypertensive, obese, anticoagulated because of an atrial fibrillation and pelvic organ prolapse. Initially, conservative treatment was offered due to the high surgical risk, but sometime later the patient came to the emergency department with enterocele and risk of intestinal ischemia. Results: After placing the patient in the Trendelenburg position and applying ice to the perineum, the prolapse is reduced. Subsequently, urgent surgical intervention is performed with a total vaginal hysterectomy, anterior colporrhaphy, Ritcher's operation and colpoperineorrhaphy. This intervention solved the patient's clinical condition and also avoided the small bowel ischemia. Conclusion: The diagnosis of advanced enterocele with risk of intestinal obstruction is a very rare but potentially serious clinical case. The immediate recognition and management are very important because of the risk of vaginal rupture, intestinal necrosis, and also systemic infection.