Anterior enterocele as an etiology for anterior vaginal wall prolapse: a magnetic resonance defecography case series

Pelvic floor hernias from the posterior cul-de-sac most often contain small bowel and are called enteroceles, however may contain sigmoid colon (sigmoidocele) or only peritoneal fat (peritoneocele). These cul-de-sac hernias typically cause bulging of the posterior vaginal wall, while anterior vaginal wall bulges are typically secondary to bladder prolapse in patients with pelvic floor deficiency. We report a series of seven patients who presented with anterior vaginal wall “mass” or bulge after cystectomy and were found on magnetic resonance defecography (MRD) to have enteroceles or sigmoidoceles in the anterior rather than posterior compartment. MRD was instrumental for diagnoses in these patients and to exclude local recurrence of bladder malignancy. We also report five additional patients that were found to have bowel herniation anterior to the vaginal apex, but without history of cystectomy.