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 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 radiograph

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.