Inguinal canal

Extends between the deep (internal) and superficial (external) ring

Roof (superior): internal oblique and transversus abdominis muscles
Floor (inferior): inguinal ligament (shelving edge of external oblique) and lacunar
ligament (medially)
Posterior wall: transversalis fascia laterally; conjoint tendon medially
Anterior wall: external oblique aponeurosis and internal oblique muscle laterally

Hesselbach triangle borders
Medially: rectus abdominis muscle
Laterally: inferior epigastric vessels
Inferiorly: inguinal ligament
 Hernia: A protrusion of a structure through a weakness or opening in the wall of a
surrounding cavity. (Amboss)

 Inguinal hernia: protrusion of intraabdominal contents (most commonly fat)

through the inguinal canal.

o Direct: Medial to inferior epigastric directly through the posterior wall of

the inguinal canal.

o Indirect: lateral to inferior epigastric through deep inguinal ring.

Further divided into:

 Uncomplicated: hernia completely reducible w/o features of incarceration,
strangulation, or bowel obstruction.

 Complicated: w/ features of incarceration, strangulation, or bowel obstruction.

A type of hernia in which the contents

of the hernial sac cannot return
through the abdominal wall defect surgical emergency
into the peritoneal cavity with the
application of gentle external
pressure. Increases the risk of
subsequent strangulation and bowel
obstruction. Manual reduction of the
hernia may be considered as a
temporizing measure before surgery.

Occult hernia: Not identifiable on physical examination.

Diagnosis:

1- Clinical (MAINSTAY)
 2- Imaging can be used if uncertain (Ultrasound)

Management:

1- Surgery (Open/ Laparoscopic)

Overview of hernias

Inguinal hernia 
Femoral hernia
Indirect Direct

 Most common type of hernia (∼ 75% of all cases)

 Indirect inguinal hernia > direct inguinal hernia  Less com

5% of all
Epidemiology  More common
in male infants (associated  More common in older  More co
with premature birth) and older men
men

 Most commonly congenital: due

 Acquired
to incomplete obliteration of
the processus  Acquired: due to increase
Etiology weakening of
vaginalis during fetal pressure
development the transversalis fascia weakene
 Can also be acquired floor (e.g

 Only herniates through

 Herniates through external and
external ring
internal ring
 Within the Hesselbach
 Outside of the Hesselbach  Herniate
triangle
triangle ring into
 Medial to the inferior
Location  Lateral to the inferior  Below th
epigastric blood
epigastric blood vessels  Lateral to
vessels and lateral to
 Surrounded by the external  Medial t
the rectus abdominis
spermatic fascia, cremasteric
 Only surrounded by
muscle fibers, and internal
the external spermatic
spermatic fascia
fascia

Clinical  Mass in the inguinal region that may increase in size  Groin bu

 when coughing (Valsalva maneuver) 
features ligament
 Indirect inguinal hernias are associated with a communicating
the pubi
hydrocele.

 Typically, a clinical diagnosis

Diagnostics
 Imaging: ultrasound of the groin

Treatment  Surgical repair