Internal supravesical hernias (alternative plural: herniae) are a type of internal hernia in which viscera protrude into the supravesical fossa, occupying the paravesical space.
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Epidemiology
It is a very rare condition and accounts for less than 4% of all internal herniae 4.
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 3:
- 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 1.
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