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.