Goglia Lorenzo, MD, ASL TOSCANA NORD OVEST, Lucca.
Bracco Gianluca MD, PHD, ASL TOSCANA NORD OVEST, Lucca.
Simi Giovanna MD, ASL TOSCANA NORD OVEST, Lucca.
Nanini Chiara MD, ASL TOSCANA NORD OVEST, Lucca.
Puccetti Simone MD, PHD, ASL TOSCANA NORD OVEST, Lucca.

Herniation of small bowel through the posterior vaginal wall is extremely rare type of  perineal hernia. Here, we describe a case of a 70-year-old hospidalized for a mass the size of an apple, painful, with limited consistency, reducible, accompanied by intestinal gurgling, pulsating on cough. The patient's own medical history included abdominal hysterectomy for fibroma uteri and anal cancer for which she had undergone an abdominoperineal resection.
Without improvement symptom by conservative management, an operation is performed. The patient is placed in a modified lithotomy position and the first incision is made horizontally in the perineal region to dissect the posterior vaginal wall and mobilize the rectovaginal fascia. The elytrocele's sac can be palpated between two fingers and subsequently opened to confirm the diagnosis. Opening the elytrocele's sac also allows the pushing back of any intestines before grasping the peritoneum with a heart-shaped forceps on its anterior and posterior parts. Elytrocele dissection is completeted by interposition of a proven synthetic, bioabsorbable mesh (GORE® BIO-A® Hernia Plug). The perineorrhaphy is performed with two horizontal sutures. There is a good postoperative evolution.  The case represents a rare type of internal hernia and provides published cases of hernia through a peritoneal defect of the posterior vaginal wall.


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