Indirect inguinal hernia

Last revised by Craig Hacking on 21 Feb 2024

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Hacking C, Knipe H, et al. Indirect inguinal hernia. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-1499

DOI:

https://doi.org/10.53347/rID-1499

Permalink:

https://radiopaedia.org/articles/1499

rID:

1499

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

21 Feb 2024, Craig Hacking ◉ ◈

Disclosures:

At the time the article was last revised Craig Hacking had the following disclosures:

Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Craig Hacking's current disclosures

Revisions:

23 times, by 15 contributors - see full revision history and disclosures

Systems:

Gastrointestinal, Musculoskeletal

Tags:

re-write

Synonyms:

Indirect inguinal hernias
Indirect inguinal herniation
Indirect inguinal herniae

Indirect inguinal hernias (alternative plural: herniae), a type of groin herniation, are the most common type of abdominal hernia.

Indirect inguinal hernias arise lateral and superior to the course of the inferior epigastric vessels, lateral to Hesselbach's triangle, and then protrude through the deep (internal) inguinal ring into the inguinal canal. The hernial sac and content often pass inferomedially within the canal to emerge via the superficial inguinal ring.

Gender differences

males: they enter the canal anterior to the spermatic cord and may extend through the superficial inguinal ring into the scrotum
females: they tend to follow the round ligament into the labia majora

Contents may include mesenteric fat (most common), peritoneal fluid, small bowel loops, mobile colon segments (sigmoid, cecum, appendix).

Treatment and prognosis

Complications

incarceration: the most common complication associated with inguinal hernias, the incidence could be as high as 30% for infants younger than 2 months
strangulation with bowel ischemia and perforation
intestinal obstruction

Differential diagnosis

On imaging, consider:

direct inguinal hernia
- emerges medially to the inferior epigastric vessels and above the inguinal ligament
- the inguinal canal is usually compressed/displaced ("lateral crescent sign")
femoral hernia
- exit below the inguinal ligament and caudal to the emergence of the inferior epigastric vessels

On testicular ultrasound, one could consider spermatic cord lipoma on the differential if an inguinal hernia contains only omental fat. Movement of the fat with the Valsalva maneuver is more likely an indirect hernia.

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References

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