Pouch of Douglas Descent – Symptoms, Treatment

Pouch of Douglas Descent – Symptoms, Treatment

Pouch of Douglas Descent/Sigmoidocele is an uncommon accompaniment of pelvic prolapse. It is difficult to detect a sigmoidocele during clinical pelvic examination, and as a consequence, a sigmoidocele may be unexpectedly encountered during vaginal repair of pelvic prolapse. The author has discovered and repaired a sigmoidocele during vaginal surgery in 4 patients with either complete procidentia or vaginal vault eversion. The procedure involves a modification of the bilateral sacrospinous vaginal vault fixation using two additional sutures to suspend the sigmoid colon from the sacrospinous ligament. Clinical and functional results have been excellent. This is the first description of a vaginal approach to the repair of a sigmoidocele.

Sigmoidocele (also known as Pouch of Douglas descent) refers to a condition where the sigmoid colon descends (prolapses) into the lower pelvic cavity. [rx] This can obstruct the rectum and cause symptoms of obstructed defecation.[rx]

Symptoms of Sigmoidocele

Many women may notice a bulge in their vagina. They may also notice dragging or a feeling of pressure particularly towards the end of the day or if they have been on their feet for a few hours.

As the bulge gets bigger sometimes it can be more difficult to completely empty their bowels. This is because the bulge presses on the front of the rectum. Sometimes the bulging gives the sensation that there is still more bowel movement to pass even though the lower bowel is empty.

Diagnosis of Sigmoidocele

It is important to make sure that it is the enterocele or sigmoidocele that is causing the bowel problem. Most women will require some form of endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy to ensure that it is otherwise healthy.

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The most useful test for the enterocele or sigmoidocele itself is a videoproctogram. or MRI program. These tests should confirm that there is a bulge and that it is causing an obstruction to defaecation. It is also useful to ensure that there are not any other areas of prolapse such as an internal prolapse or a rectocele which would require treatment at the same time.

Most women will also have tests of their sphincter muscle function (anorectal physiology) and an endoanal ultrasound scan to look for any damage to the muscle.

Treatment of Sigmoidocele

If symptoms are minimal then no surgical treatment may be necessary. Keeping the stools soft and avoiding straining should help to prevent the enterocele or sigmoidocele from getting larger. Sometimes glycerine suppositories or small enemas will help to empty.

For most women who have an enterocele or sigmoidocele that is causing pressure symptoms or problems with bowel emptying, a repair is recommended. The type of repair will depend on whether there is any other pelvic floor weakness or prolapse. An operation to repair an enterocele through the vagina may be performed in conjunction with a gynecologist. Sometimes a ventral mesh rectopexy may be considered particularly if internal rectal prolapse co-exists.



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