Indirect inguinal hernia
Citation, DOI, disclosures and article data
At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt 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- 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.
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Epidemiology
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.
Clinical presentation
Many are longstanding and asymptomatic, although the sheer size can become burdensome.
Pathology
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
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
Differential diagnosis
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.
Quiz questions
References
- 1. Shadbolt CL, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. Radiographics. 2001;21 Spec No : S261-71. Radiographics (full text) - Pubmed citation
- 2. Burkhardt JH, Arshanskiy Y, Munson JL et-al. Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings. Radiographics. 2011;31 (2): E1-12. Radiographics (full text) - doi:10.1148/rg.312105129 - Pubmed citation
- 3. Suzuki S, Furui S, Okinaga K et-al. Differentiation of femoral versus inguinal hernia: CT findings. AJR Am J Roentgenol. 2007;189 (2): W78-83. doi:10.2214/AJR.07.2085 - Pubmed citation
- 4. Hahn-Pedersen J, Lund L, Højhus JH et-al. Evaluation of direct and indirect inguinal hernia by computed tomography. Br J Surg. 1994;81 (4): 569-72. Pubmed citation
- 5. Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT. Clin Radiol. 2008;63 (2): 184-92. doi:10.1016/j.crad.2007.07.018 - Pubmed citation
Incoming Links
- Busoga hernia
- Canal of Nuck
- Hesselbach triangle
- Lateral umbilical folds
- Testicular development and descent
- Hydrocele of the canal of Nuck
- Lateral fossa
- Direct inguinal hernia
- Abdominal hernia
- Pantaloon hernia
- Medical abbreviations and acronyms (I)
- Groin herniation
- Extratesticular cystic lesions (differential)
- Inguinal hernia
- Round ligament varicosities
- Female inguinal canal
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