Primary Supravesical Hernia Presented as Direct Inguinal Hernia with an Unusual Internal Opening – A Case Report

Abstract

Introduction: Supravesical hernia (SVH) or paravesical hernia is a rare condition and it is believed to be caused due to Weakness between the transversus abdominis aponeurosis and the transversalis fascia. They are mainly acquired and usually associated with inguinal hernia. The external and the internal variety of SVH is commonly presented as direct inguinal hernia and intestinal obstruction or undiagnosed abdominal pain respectively.  Case Report: A 40 year old male was posted for TransAbdominal PrePeritoneal (TAPP) hernia repair for a direct inguinal hernia. Intraoperatively we diagnosed him with a supravesical hernia with an unusual internal opening over the medial umbilical ligament. Discussion: SVH is a rare variety of pelvic hernia which protrudes through Supra Vesical or Paravesical Fossa (SVF). SVF is an area above the urinary bladder between the median umbilical ligament and medial umbilical ligament. CT/MRI sometimes helps in obtaining the diagnosis but mainly it was made intraoperatively. Simple closure of the internal opening is sufficed for treating this form of hernia. Conclusion: Preoperative diagnosis of SVH is difficult to establish. CT/MRI can sometimes diagnose internal SVH but in majority, the diagnosis was made intraoperatively. Whenever we are dealing with direct inguinal hernia we should be aware of the possibility of this rare form of hernia especially if there is any difference in anatomical relation during surgery.