Acute abdomen due to strangulated intravesical hernia with incidental finding of kidney tumor: a case report and literature review

Abstract

Internal supravesical hernia is a rare type of internal abdominal hernia with overall incidence <4% of all internal abdominal hernias. The clinical diagnosis is a major preoperative diagnostic challenge for both the surgeon and the radiologist. It is a rare cause of small bowel obstruction, but in case of strangulation it can be fatal and it necessitates urgent surgical intervention. In this case study, we report a case of intravesical type of supravesical hernia in a 63-year-old man with acute intestinal obstruction and an accidental finding of a kidney tumor. In the article, we discuss the clinical picture, diagnosis, risk factors, treatment strategy and complications of this rare entity.

The role of CT in acute bowel obstruction due to a supravesical hernia, a case report from Nepal

“…It is mainly due to antero-superior enlargement of the bladder during its filling entraping the intestine in the supravesicular diverticulum whenever present. In females, there is lateral enlargement of the bladder during filling, which forces supravesical diverticular contents upward and outward, thus making the hernia relatively uncommon 6 , 19 . The overall incidence of supravesical hernia is less than 4% among all internal abdominal hernias 14 , 19 .…”

“…In females, there is lateral enlargement of the bladder during filling, which forces supravesical diverticular contents upward and outward, thus making the hernia relatively uncommon 6 , 19 . The overall incidence of supravesical hernia is less than 4% among all internal abdominal hernias 14 , 19 . Around 60 cases of supravesical hernias have been reported till date in the literature worldwide 20 , 21 .…”

“…The major risk factors associated with abdominal wall hernias encompass prematurity, a positive family history marked by congenital weakness in the transversus abdominis muscle, male gender, smoking habits leading to decreased collagen production, advanced age, and conditions characterized by defective collagen synthesis, such as Ehlers-Danlos Syndrome or Marfan’s Syndrome 23 . It is likely an acquired condition, influenced by the concave peritoneal depression of the paravesical space, primarily due to atrophy of peritoneal fat resulting from factors like aging, malnutrition, and disease 18 , 19 . These factors predispose to the development of inflammatory areas and subsequent scarring, creating conditions conducive to hernia formation 19 .…”

“…It is likely an acquired condition, influenced by the concave peritoneal depression of the paravesical space, primarily due to atrophy of peritoneal fat resulting from factors like aging, malnutrition, and disease 18 , 19 . These factors predispose to the development of inflammatory areas and subsequent scarring, creating conditions conducive to hernia formation 19 . Furthermore, a potential cause is suggested to be dysraphism between Cooper’s ligament and the transversalis fascia, arising from sub-peritoneal tissue-fibrillary contraction following inflammation 18 , 19 .…”

“…These factors predispose to the development of inflammatory areas and subsequent scarring, creating conditions conducive to hernia formation 19 . Furthermore, a potential cause is suggested to be dysraphism between Cooper’s ligament and the transversalis fascia, arising from sub-peritoneal tissue-fibrillary contraction following inflammation 18 , 19 . Increased intra-abdominal pressure can also lead to this type of hernia 19 .…”