Indirect inguinal hernia
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At the time the article was created Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
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It is five times more common than a direct inguinal hernia, and is seven times more frequent in males, due to the persistence of the processus vaginalis during testicular descent.
In children, the vast majority of inguinal hernias are indirect.
Many are longstanding and asymptomatic, although the sheer size can become burdensome.
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 or internal inguinal ring into the inguinal canal. An indirect hernia enters the inguinal canal at the deep ring, lateral to the inferior epigastric vessels. It passes inferomedially to emerge via the superficial ring and, if large enough, extend into the scrotum.
Treatment and prognosis
incarceration: the most common complication associated with inguinal hernias, the incidence could be as high as 30% for infants younger than 2 months
On imaging, consider:
emerges medially to the inferior epigastric vessels and above the inguinal ligament
the inguinal canal is usually compressed/displaced ("lateral crescent sign")
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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