Fig. 16

Severe enterocele with vaginal vault prolapse, urethral hypermobility and urinary obstruction. (a, b) Sagittal midline TrueFISP images at rest (a) and during evacuation (b) of a patient previously submitted to hysterectomy, showing an enterocele. Note the herniation of small bowel loops into the rectovaginal septum. It is difficult to identify correctly the vaginal apex, but it is clear it is located below the PCL (red line), corresponding to a vaginal vault prolapse. The volume of the enterocele is so large that its mass effect over the vagina and urethra pushes them anteriorly, inducing also an horizontalization of their normal vertical axis—urethral hypermobility (white arrow)—and inducing obstruction of the bladder (the urinary volume of the bladder on both phases is similar, always above the PCL). Note also that the bladder is more distended than it should be. Although not relevant for this specific case, the bladder should be half distended, as preconized by the ESUR/ESGAR recommendations. Orange line: extent of the enterocele