Key clinical message:
Supravesical hernias are rare but can be a cause for intestinal
obstruction due to the confinement of loops in the supravesical fossa.
Their diagnosis is difficult, but morphological examinations such as CT
scan can lead to a preoperative diagnosis.
Case presentation :
We report the case of a 61 year old male who was admitted with a twenty
four hour history of small bowel obstruction. He had experienced
gradually increasing nausea, vomiting, and abdominal pain. He had no
history of abdominal surgery or abdominal trauma. The physical
examination showed abdominal distension with a non complicated left
inguinal hernia. Abbdominal X-ray showed dilated small bowel loops with
air–fluid levels. The computed tomography (ct) scan showed signs of
small bowel obstruction with an image of a transitional zone in the left
lower quadrant of the abdomen (figure a ). The hernia sac was
situated behind the left lower abdominal wall above the urinary bladder
(figure b ).
We decided to do a laparoscopic exploration of the abdominal cavity,
wich showed an incarcerated small bowel loop in a left lateral pouch in
the supravesical fossa (figure c ). The hernia was reduced and
the small bowel loop’s vitality was doubtful. The defect in the
supravesical fossa measured 2cm (figure d ). Therefore we
converted to laparotomy in order to do the small bowel resection and
treat the hernia defect. We made a resection of 10 cm of the devitalised
loop with an immediate anastomosis and the defect was closed. The
patient recovered uneventfully.