Anterior-Only Sacrocolpopexy Complicated by Obstructive Enterocele: Should Both Compartments Always Be Repaired?

Abstract

Sacrocolpopexy is widely regarded as the gold standard for apical prolapse repair, yet the extent of mesh placement remains debated. While some surgeons routinely place both anterior and posterior meshes, others favor a compartment-specific approach. We report the case of a 60-year-old woman with prior hysterectomy and anti-incontinence mesh surgery who underwent anterior-only robot-assisted sacrocolpopexy for apical and anterior prolapse. Six weeks later, she developed incomplete bowel emptying, pelvic pressure, and a posterior vaginal bulge. Examination revealed posterior compartment prolapse, and MRI defecography confirmed an obstructive enterocele with small bowel descent, rectocele, and intussusception. After multidisciplinary discussion, she underwent robot-assisted posterior sacrocolpopexy combined with rectopexy, including posterior mesh placement and Douglas closure. The postoperative course was uneventful, and symptoms resolved at the four-month follow-up. This case highlights obstructive enterocele as a rare but clinically significant complication of anterior-only sacrocolpopexy and underscores the need for individualized surgical planning and vigilance for postoperative bowel dysfunction, supporting a selective approach in which posterior support may be considered when posterior compartment weakness or bowel dysfunction is evident.