anatomy

Direct Hernia vs Indirect Hernia

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:

  1. Inferior epigastric vessels
  2. Inguinal ligament
  3. Lateral border of the rectus abdominis
Direct Inguinal HerniaIndirect Inguinal Hernia
Medical to epigastric vesselsLateral to epigastric vessels
Cause: Abdomen strain/muscle weaknessCause: Problems with processus vaginalis descent for baby boys
AcquiredUsually inherited
Location: Hasselbach’s Triangle and directly behind superficial inguinal ringLocation: Coming out from Deep Inguinal Ring, descending to scrotum
Rarely in scrotumCan pass into scrotum
Common in elderly men with weak abdominal musclesCommon 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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