Supravesical hernia in a five year old male: a case report

Supravesical hernias are defined as a protrusion of the abdominal viscera through the supravesical fossa. They are a rare type of hernia and occur infrequently in the pediatric population. A five-year-old male with a history of prematurity and prior indirect and direct inguinal hernia repairs at three months old presented with a right groin bulge which occurred only with urination. The bulge never required manual reduction and would resolve spontaneously. His grandmother first noticed the bulge when the patient was two years old and denied any associated pain. Laparoscopic evaluation did not demonstrate a left or right inguinal hernia. Although there was evidence of previous left indirect inguinal hernia repair and right direct inguinal hernia repair, there was no evidence of recurrence. Instead, laparoscopy revealed a right-sided hernia defect medial to the medial umbilical ligament with partial attachment to the bladder, consistent with a right external supravesical hernia. The supravesical hernia was repaired in an open fashion, with the incision placed slightly medial to a typical inguinal hernia repair. Dissection proceeded to the external oblique, which was not opened as the hernia was medial to the external ring. The hernia sac was identified and opened, revealing an extraperitoneal defect. The sac was closed and gently reduced back into the extraperitoneal space, and the fascial defect was closed. Laparoscopy was again introduced to confirm bladder preservation and a tension-free repair. At one-month follow-up, the patient and family reported complete resolution of symptoms with no pain or groin bulge present. Although pediatric supravesical hernias are extremely rare, they should be considered in the differential diagnosis when a patient presents with hernia-like symptoms associated with urination.