Answer Happy

4. PREOPERATIVE DIAGNOSIS: Third-degree enterocele. POSTOPERATIVE DIAGNOSIS: Same. OPERATION PERFORMED: Repair of enterocele. OPERATIVE FINDINGS: The patient was found to have a vagina that was completely turned inside out. There was nothing in the way of any good tissue of any kind to repair with or anything in the abdomen that I could suture anything to. The first incision took us right into the peritoneal cavity. Under satisfactory general endotracheal anesthesia with the patient in a ithotomny position, the perineum, vagina, and abdomen were prepared with prisohex and draped with sterle drapes and the drapes were sutured in place. A pelvic examination was done, and nothing could be feit in the pelvis. The catheter was inserted and the bladder emptied of about 700 cc of clear urine, and she had just urinated not more than five minutes before that. The apex of the vagina was grasped with Allis forceps. An Incision about 3-4 cm long was made in a transverse manner, and this took us right into the peritoneal cavity. Then searching for anything in the way of uterosacral ligaments or anything was completely futile. There was nothing inside that could be used. Therefore, the bladder and rectum were dissected free from the anterior and posterior vagina mucous membrane. These mucous membranes were divided in the midine up to a point where we could feel where the defect was in the peritoneum, and then we just closed the peritoneum with a continuous suture of 2-0 Vicry. Then we inverted all of the excess tissue that was hanging down into the vagina and inverted it into the pelvis and sutured it with interrupted 0 PDS suture in a horizontal mattress-type suture. This seemed to give her some support, but there was just no good tissue at all to repair with. The mucous membrane was edematous and Luce were inverted and seemed to be holding pretty well, the lood in the