Supravesical hernias: a systematic review of the literature

Abstract

Background: A supravesical hernia (SH) is a rare abdominal wall hernia that is defined by the protrusion of abdominal viscera through the supravesical fossa. The objective of this study was to review current literature on SHs and elucidate their clinical manifestations and preferred therapeutic approach. Methods: PubMed, Embase and Cochrane bibliographical databases were searched (last search: 30 March 2020) for articles reporting on SHs. Results: Thirty-four studies met our inclusion criteria and involved collectively 38 patients (94.7% males) with an age of 59.57 AE 14.84 (mean AE standard deviation) years. Abdominal pain (81.6%) and nausea and vomit (71.1%) were the most frequently encountered symptoms. The majority of patients (78.1%) had signs of bowel obstruction. Twenty-nine patients (76.3%) suffered from an internal SH, while nine (23.7%) had an external one. An open hernia repair was conducted at 29 patients (76.3%), while eight (21.1%) had a laparoscopic approach and in one case (2.6%) the laparoscopic operation was converted to an open one. A mesh was applied at 14.3% of included cases. Eight patients (21.1%) underwent a bowel resection and hernia sac was resected at six (15.8%) cases. Four patients (11.8%) experienced postoperative complications and one patient (2.9%) died on first postoperative day. Conclusion: SH is an extremely rare type of hernia occurring through the supravesical fossa between the remnants of urachus and foetal umbilical arteries. All clinicians should be aware of this entity and further studies are necessary in order to clarify their aetiology, true incidence and optimal therapeutic approach.

Intestinal obstruction revealing a rare case of a supravesical internal hernia

“…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).…”

Strangulated supravesical hernia: an unusual cause of mechanical small bowel obstruction

“…It can be suspected on an abdominal scan. 3 In fact, the CT scan can show a major sign which is an incarcerated intestine in front of the bladder. It can also show a hernial pseudosac which can contain several intestinal loops or a single small loop as was our case.…”

“…Medline laparotomy is mostly preferred since this pathology is frequently revealed by an acute intestinal obstruction, but the laparoscopic approach is possible. 3,4 In a recent review article published in 2020, the authors insist on that there are no Gold standard but the laparoscopic approach is not inferior since it seems that laparoscopy offers a clearer vision of the operating field and reduces hospital stay. 3 The treatment consists in the reduction of the content of the hernial sac, verifying its vitality and closing the hernial orifice.…”

“…The incidence of supravesical hernias remains difficult to assess as they are a rare form of internal hernia. It can be suspected on an abdominal scan 3 . In fact, the CT scan can show a major sign which is an incarcerated intestine in front of the bladder.…”

“…It can also show a hernial pseudosac which can contain several intestinal loops or a single small loop as was our case. 3 Surgery remains the mainstay of treatment. Medline laparotomy is mostly preferred since this pathology is frequently revealed by an acute intestinal obstruction, but the laparoscopic approach is possible.…”