Inguinal Hernias

Inguinal Canal

The inguinal canal is what allows the spermatic cord and it’s contents to travel from inside the abdominal cavity to outside the cavity within the scrotum. It is a tube that runs between the deep ring (the entrance to the abdominal cavity) to the superficial ring (the exit into the scrotum). Weakness in these rings can lead to herniation of bowel through the canal and into the scrotum. This is an indirect inguinal hernia.

Inguinal canal (Hesselbach’s triangle) boundaries:

RIP“ mnemonic

  • Recus abdominis (medial boarder)
  • Inferior epigastric vessels (superior/lateral boarder)
  • Poupart’s ligament (AKA inguinal ligament) (inferior boarder)

 

Femoral triangle boundaries:

SAIL” mnemonic

  • Sartorius (lateral boarder)
  • Adductor longus (medial boarder)
  • Inguinal Ligament (superior boarder)

 

Indirect Inguinal Hernia

  • Normally after the testes descend through the inguinal canal, the internal inguinal ring closes and the processus vaginalis is obliterated.
  • In some patients the inguinal ring remains patent, and the processus vaginalis remains intact
  • This leaves a tracts or tunnel from the abdominal contents, through the internal inguinal ring, along the inguinal canal and into the scrotum
  • The bowel herniates along this tract from the internal inguinal ring to the scrotum
  • If the hernia is reduced and pressure is applied (with two fingertips) to the internal inguinal ring (at the mid-way point from the ASIS to the pubic tubercle), the hernia will remain reduced

 

Direct Inguinal Hernia

  • Due to weakness in the abdominal wall around Hasselbach’s triangle
  • The hernia protrudes directly through the abdominal wall (not along a canal or tract like an indirect inguinal hernia)
  • Pressure over the internal ring will do nothing to stop the herniation

 

Inguinal hernia differentials:

  • Femoral hernia
  • Lymph node
  • Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
  • Femoral aneurysm
  • Abscess
  • Undescended/ectopic testes
  • Kidney transplant
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