Case List History Objectives Radiology Images Questions HERNIAS Case #1 - A 17 year old with a bulge in his R groin DISCUSSION QUESTIONS: 5.) What is the difference anatomically and clinically between indirect and direct inguinal hernias? Definitions: Indirect inguinal hernia: defect located lateral to inferior epigastric vessels with sac through the internal inguinal ring. Sac is located anterior and medial to cord structures and may extend into the scrotum. This is a congenital defect. Direct inguinal hernia: defect in posterior wall of inguinal canal medial to inferior epigastric vessels (Hesselbach's triangle). This is an acquired hernia. It does not extend into the scrotum. Pantaloon hernia: direct and indirect hernias coexist. Femoral hernia: sac is in the femoral canal medial to the femoral sheath. Sliding hernia: an organ such as colon or bladder makes up a wall of the hernia. Richter's hernia: only the antimesenteric wall of the bowel is trapped in the hernia sac. Littre's hernia: a Meckel's diverticulum is found in the sac.
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