The role of computed tomography in acute bowel obstruction due to a supravesical hernia: a case report from Nepal

Introduction and importance: Supravesical hernias are rare internal hernias but potential cause of small-bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male sex, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis.

Case presentation: The authors are reporting a case of small-bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small-bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small-bowel obstruction.

Clinical discussion: The case focuses supravesical hernia as a rare yet life-threatening etiology of small-bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of CT scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of CT scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons.

Conclusion: Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.