Re: Recurrent rectocele
From: Andrew Folley (agfolley@hotmail.com)
Thu Nov 30 07:08:52 2006
Consider future repair with Apogee syteby AMS using mesh. andrew
>From: "Elrod, Darryl G Maj 48 MDOS/SGOBO" <Darryl.elrod@LAKENHEATH.AF.MIL>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Recurrent rectocele
>Date: Thu, 30 Nov 2006 02:20:30 -0600
>
>I figured I'd change the tone of the conversation to something along the
>clinical lines.
>
>35 yo G4P4 with TVH/abdominal paravaginal repair/Burch/McCalls and a
>posterior repair with perineorrhaphy about a year ago presents back for
>recurrent rectocele symptoms. Although not as bad as before surgery,
>she still feels the need to splint with bowel movements and has
>increased pressure rectally.
>
>On exam there is still a significant bulge in the posterior vagina. On
>rectal exam, the sphincter feels intact, the posterior vaginal wall can
>be brought nearly to the hymen (better than before her last surgery when
>I could bring it past the hymen). The anterior vagina and the cuff are
>well suspended. I don't feel anything that would make me concerned for
>an enterocele and the upper half of the vagina there feels to be good
>support.
>
>Endoanal ultrasound shows a normal internal and external sphincter.
>
>Under normal circumstances I wouldn't be to concerned about either
>tackling this repair myself or sending her to a urogyn to repair.
>However, I got one of those turn the head, get red with embarrassment
>looks from her. I questioned what that was for and got 'do you think
>this might have something to do with liking anal sex???' Turns out, she
>likes it enough to not really want to be without it for any lengthy
>period of time.
>
>Oddly enough, I can't seem to find much literature at all on management
>of recurrent rectocele and none on risk of recurrent rectocele with anal
>sex.
>
>Any thoughts on a) if this would be enough to undo a perfectly good
>posterior repair (probably) b) if you repaired it again, how long would
>you prescribe nil per anus (6 months???) c) would you tackle this
>yourself or refer?
>
>Thanks,
>
>Glen
>
>//SIGNED//
>
>D. Glen Elrod, Maj., USAF, MC
>
>Obstetrician/Gynecologist
>
>Chief of Obstetrics
>
>48 MDOS/SGOBO
>
>RAF Lakenheath, England
>
>Telephone DSN: 314-226-8130
>
> Comm: +44 (0) 1638 52 8130
>
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