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      Obstrucción intestinal debido a hernia estrangulada en el espacio prevesical: presentación de un caso y revisión de la literatura Translated title: Intestinal obstruction caused by strangulated hernia in the prevesical space: One case and revision of the literature

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          Abstract

          Resumen Introducción El espacio prevesical es una localización infrecuente de hernia. La hernia prevesical es causa infrecuente de obstrucción intestinal. Presentamos el caso de un paciente intervenido en nuestro centro y realizamos una revisión de la literatura. Caso clínico Varón de 67 años sin antecedentes médico- quirúrgicos de interés que acude a Urgencias por dolor suprapúbico de 24 h de evolución. A la exploración destacan distensión abdominal y dolor en la localización previamente descrita. Se realiza estudio analítico completo y TC abdominal, en el que se objetiva dilatación de asas del intestino delgado con cambio de calibre a nivel pélvico. Se decide realizar laparotomía exploradora: herniación de 25 cm de íleon de aspecto isquémico en el espacio prevesical. Se realiza resección intestinal y anastomosis enteroentérica L-L manual monoplano. El estudio anatomopatológico de la pieza quirúrgica no revela otros datos de interés. El paciente presenta buena evolución postoperatoria con tolerancia oral progresiva y es dado de alta al quinto día de la intervención. Conclusiones Las hernias del espacio prevesical son causa infrecuente de dolor abdominal y de obstrucción intestinal. Se localizan entre los ligamentos umbilicales laterales y el fundus de la vejiga, donde se forma un anillo peritoneal. Deben sospecharse ante dolor inguinal o supra-púbico sin tumoración palpable en el piso abdominal inferior. El diagnóstico es radiológico, mediante TC. El tratamiento es quirúrgico y ocasionalmente puede precisar resección intestinal.

          Translated abstract

          Introduction Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.

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          Most cited references 7

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          Internal supravesical hernia as a rare cauase of intestinal obstruction: a case report

          Introduction Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are often the cause of intestinal obstruction. We describe the anatomical variant of the supravesical hernia in this case and discuss the pre-operative findings revealed by computed tomography. We discuss diagnostic and therapeutic procedures, and review other anatomical variants. Case presentation A 60-year-old Senegalese man was admitted with a two-day history of small bowel obstruction. A physical examination showed abdominal distension. An abdominal X-ray revealed dilated small bowel loops. A computed tomography scan showed an image at the left iliac fossa that suggested an intussusception. A median laparotomy showed a left lateral internal supravesical hernia. The hernia was reduced and the defect was closed. The patient recovered uneventfully. Conclusions Supravesical hernia is a possible cause of intestinal obstruction and diagnosis is very often made intraoperatively. Morphological examinations, such as computed tomography scanning, can lead to a preoperative diagnosis. Laparoscopy may be useful for diagnosis and therapy.
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            Internal and external supravesical hernia.

            Two cases of supravesical hernia are described. One was a rare posterior internal supravesical hernia discovered only at exploratory laparotomy after exhaustive but fruitless diagnostic procedures. The surgical anatomy of anterior and posterior internal supravesical hernia is discussed and a simplified terminology is proposed.
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              Supravesical hernia A rare cause of intestinal obstruction

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rchcir
                Revista chilena de cirugía
                Rev Chil Cir
                Sociedad de Cirujanos de Chile (Santiago, , Chile )
                0718-4026
                2018
                : 70
                : 1
                : 75-78
                Affiliations
                Madrid orgnameHospital Universitario Rey Juan Carlos I España
                Madrid orgnameHospital Universitario Puerta de Hierro España
                Article
                S0718-40262018000100075
                10.1016/j.rchic.2017.01.007

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 4
                Product
                Product Information: SciELO Chile

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