Discussion :
A supravesical hernia (SH) is a rare abdominal wall hernia that is
defined by the protrusion of abdominal viscera through the supravesical
fossa (1). There are two variants of supravesical hernias: an external
form caused by the laxity of the vesical preperitoneal tissue with a
hernia sac usually that protrudes through the anterior abdominal wall,
and an internal one with a growing hernia sac from back to front and
above the bladder in a sagittal paramedian direction (2). External
supravesical hernia is more common than internal supravesical hernia,
and it is difficult to make a differential diagnosis from inguinal
hernia. The great majority of internal supravesical hernias occupy a
prevesical location in the space of Retzius. These supravesical hernias
occur predominantly in male adults. It has been suggested that the
bladder filling in males causes an anterosuperior enlargement that traps
intestines in supravesicular diverticula when present, while in the
female, the distention of the bladder occurs laterally and forces
supravesical diverticular contents upward and outward (3). The diagnosis
of this rare cause of intestinal obstruction is usually made only at
operation. But, the knowlege of the anatomy of the supravesical fossa
may allow preoperative diagnosis by CT, as demonstrated the report by
Sasaya et al (4).
Their treatment is surgical and its objective is to reduce the herniated
viscera and then suture the orifice. The excision of the hernial sac is
an unnecessary procedure and as some authors have reported, these
procedures can be done via laparoscopy (5).a