Direct vs Indirect Hernia: What is the difference between direct and indirect inguinal hernias?
In this easy-to-understand lesson, we explore the differences between direct inguinal hernias and indirect inguinal hernias. Overall, an inguinal hernia is a medical condition, where protrusion or bulge of abdominal contents into the groin area and/or inguinal canal. There are two types of inguinal hernias: 1) direct inguinal hernia and 2) indirect inguinal hernia.
Are direct or indirect hernias more common?
What are the anatomical borders of Hasselbach’s Triangle?
The borders of the Hasselbach’s Triangle are the following:
- Inferior epigastric vessels
- Inguinal ligament
- Lateral border of the rectus abdominis
|Direct Inguinal Hernia||Indirect Inguinal Hernia|
|Medical to epigastric vessels||Lateral to epigastric vessels|
|Cause: Abdomen strain/muscle weakness||Cause: Problems with processus vaginalis descent for baby boys|
|Location: Hasselbach’s Triangle and directly behind superficial inguinal ring||Location: Coming out from Deep Inguinal Ring, descending to scrotum|
|Rarely in scrotum||Can pass into scrotum|
|Common in elderly men with weak abdominal muscles||Common in men > females, because usually congenital|
Both types of inguinal hernias, both direct and indirect hernias, are more common in males than females.
Indirect hernias are more common than direct hernias in males.
Femoral hernias are more common in females than males.
Indirect Hernia Mnemonic: Indirect Hernias are IN deeeeeeppp. Indirect = Deep inguinal canal
Superficial Inguinal Ring = Where External Oblique Muscle is
Deep Inguinal Ring = Where Transversus Abdominis Muscle is
Development of Inguinal Canal
Gonads, testes or ovaries, descend through the abdominal wall cavity. The gubernaculum ligament guides gonads down, forming along with it the processus vaginalis structure that surrounds the gonad like a sac. The processus vaginalis usually degenerates later, but if it does not, this could lead to an indirect inguinal hernias. The gubernaculum over time during development becomes shorter and turns into the short scrotal ligament that tethers the balls to the scrotal sac. For females, the gubernaculum ligament becomes the ovarian ligament that attaches the ovaries to the ligament and the round ligament of the uterus.
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