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.


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


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:


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

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

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 .