ACQUIRED INGUINAL HERNIAS: Indirect + Direct
Developmental
Breakdown of collagen Aging, smoking, vitamin deficiency, I` protease activity, malnutrition
• Failure of process vaginalis to close; in O’s this is shown via internal inguinal ring failure to close

Collagen deficiency Long-term
Ehlers-Danlos and Marfan syndrome
glucocorticoid use
Weakening of connective tissues Thinning of skin and soft tissues
intraabdominal pressure Pregnancy, chronic cough, constipation, abdominal masses or fluid
Authors: Jeffery Lindgren Peter Bishay Reviewers: Brandon Hisey Vadim lablokov Usama Malik Dr. Sylvain Coderre* * MD at time of publication
Stretching of musculoaponeurotic structures weakening of the abdominal fibromuscular tissue
Quick facts: *If the hernia is not incarcerated or strangulated, then an elective surgical repair is indicated *There is no clinical test to differentiate direct and indirect inguinal hernias • CT 8 x more likely than ‘Z? for abdominal hernia • cy 20x more likely to require surgical repair •indirect the most common hernia in CT +
INDIRECT ► INGUINAL HERNIA Abdominal contents protrude though the inguinal ring
‘I` pain w. straining, heavy lifting
More pain at the end of the day
Bulge in the groin +/- pain

DIRECT INGUINAL HERNIA
Abdominal contents protrude through Hasselbach’s triangle*
*Hasselbach’s triangle, also known as the inguinal triangle, is defined by linea semilunaris (medial), inferior epigastric vessels (suprlateral) and the inguinal ligament (inferior boarder)
Herniated contents become entrapped Groin erythema Pain on palpation Strangulation Vomiting • l• pain (SURGICAL ► Incarceration EMERGENCY) (SURGICAL Yir Fever EMERGENCY) Necrosis Compromise of vascular supply • Pain, Sepsis, fistula, abscess Bowel perforation formation