Hernial Pelvic Floor Prolapse
Spontaneous development of perineal hernias is a very rare condition and many techniques have been used for repairing the pelvic floor defect. This case study is of a patient with a massive perineal hernia.



The patient is a 68-year-old healthy female (shown above) with a two-year history of posterior perineal bulging that caused discomfort and prevented her from sitting down comfortably. It was associated with obstipation and fecal incontinence. She had no history of perineal surgeries nor vaginal deliveries. Examination showed a herniation of a 22cm x 16 cm in the right buttock. Digital anal examination showed a laterally displaced rectum. A defect in the levator ani muscle group, along the posterior-lateral wall of the rectum on the right side, could be seen. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) of the lower pelvis showed a large protruding mass containing herniated loops of the sigmoid colon and part of the rectum. The right levator ani muscle could not be recognized.
During surgery, the sigmoid loop and small bowel were easily cut off the hernia sac, the hernia was removed, the levator ani defect was repaired and the rectum was restored. A vacuum drain was inserted and the skin was closed with stitches.
The patient was discharged uneventfully from hospital on the sixth day after the operation. Five years on, the patient is moving her bowels regularly, has no fecal incontinence, nor any evidence of perineal hernia recurrence.

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1 in 3 Women Has Pelvic Floor Disorder

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