Internal supravesical hernia

Internal supravesical hernias (alternative plural: herniae) are a type of internal hernia in which viscera protrude into the supravesical fossa, occupying the paravesical space.

Epidemiology

It is a very rare condition and accounts for less than 4% of all internal herniae .

Clinical presentation

Patients may complain of :

• symptoms of small bowel obstruction including abdominal pain, nausea, vomiting, and meteorism
• groin pain
• urinary symptoms

Pathology

Different types of internal supravesical hernias are described, depending on the location of the hernial sac :

• prevesical: anterior supravesical (also known as the retropubic space)
• paravesical: right/left lateral supravesical
• retrovesical: posterior supravesical 

Radiographic features

Plain radiographs

Abdominal radiographs demonstrate non-specific signs of small bowel obstruction with:

• small bowel loops dilatation
• gas-fluid levels
• pneumoperitoneum if complicated by perforation

CT

CT is the modality of choice for diagnosis and typical features are:

• dilatation of small bowel loops with a transition area in a “closed-loop” at the level of the supravesical fossa
• displacement or compression of the lateral wall of the bladder
• free peritoneal fluid
• pneumoperitoneum if complicated with perforation

Treatment and prognosis

Internal supravesical hernias require emergency surgical treatment with laparotomy/laparoscopic procedures.

If the incarcerated loops are viable:

• reduction of the incarcerated sac
• closure of the defect in the prevesical fascia

If the bowel loops are gangrenous or present doubtful viability:

• resection of the bowel loop
• end-to-end anastomosis
• closure of the defect

Complications

Delay in diagnosis and treatment may lead to intestinal ischemia, perforation and/or peritonitis.

History and etymology

The first case of internal supravesical hernia was reported in 1814 .