Anatomy Atlas

Inguinal triangle

Trigonum inguinale
Also: Hesselbach triangle
Space / regionHigh-yielddraftGI

Area of the lower anterior abdominal wall, seen from inside, where direct inguinal hernias push through a weak transversalis fascia.

Core anatomy

Location

Inferomedial part of the anterior abdominal wall, viewed from the internal (peritoneal) surface.

Boundaries
lateral
Inferior epigastric vessels
medial
Lateral border of rectus abdominis
inferior
Inguinal ligament (iliopubic tract)
floor
Transversalis fascia (reinforced medially by the conjoint tendon)
Contents
  • No structures pass through it normally; it is an area of relative weakness in the posterior wall of the inguinal canal
Notes

Mnemonic: "RIP" — Rectus abdominis (medial), Inferior epigastric vessels (lateral), Poupart (inguinal) ligament (inferior).

Mentioned in

Generated automatically from links in other entries.

Inguinal region from inside (Hesselbach triangle)The right inguinal region viewed from inside the abdomen, with the midline on the left. The inguinal ligament runs from the anterior superior iliac spine down to the pubic tubercle. The inferior epigastric vessels arise from the external iliac artery just above the ligament and ascend medially to the lateral border of rectus abdominis. The inguinal (Hesselbach) triangle is bounded by the inferior epigastric vessels laterally, the rectus abdominis medially and the inguinal ligament inferiorly; direct hernias pass through it. The deep inguinal ring lies lateral to the inferior epigastric vessels, above the middle of the ligament, where the ductus deferens and testicular vessels enter; indirect hernias enter here. Below the ligament, the femoral ring lies medial to the femoral vein; femoral hernias pass through it.Testicular vesselsIndirect hernia: through thedeep ring, lateral to the IEVAnterior superior iliac spineDeep inguinal ringInguinal ligamentInferior epigastric vessels (IEV)External iliac → femoral arteryExternal iliac → femoral veinRectus abdominisDirect hernia: through thetriangle, medial to the IEVInguinal (Hesselbach) triangle"RIP": Rectus, Inferior epigastrics,Poupart (inguinal) ligamentDuctus deferens (to the pelvis)Superficial ring(in front of this plane)Pubic tubercleFemoral hernia: through the femoralring, medial to the femoral veinRight side, seen from inside theabdomen · midline ← · not to scalemidline

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Inguinal region from inside (Hesselbach triangle). Right side seen from inside the abdomen, as at laparoscopy. The inferior epigastric vessels separate indirect hernias (lateral, through the deep ring) from direct hernias (medial, through the inguinal triangle). Femoral hernias pass below the inguinal ligament, medial to the femoral vein. The inguinal canal and superficial ring lie in front of this plane (dashed).
Original schematic, created for this atlas.
Internal view of the lower anterior abdominal wall showing the inguinal fossae and the inferior epigastric vessels
Inside view of the lower abdominal wall: the medial inguinal fossa (direct hernia site) lies medial to the inferior epigastric vessels.
Henry Vandyke Carter, Gray's Anatomy of the Human Body, 20th ed. (1918), Fig. 1036. Source · Public domain (Public domain in the US: published before January 1, 1931 (per Wikimedia Commons))

Clinical correlations

Direct inguinal hernia PANCE

Mechanism / lesion

Acquired weakness of the transversalis fascia (age, chronic straining, heavy lifting, chronic cough, connective tissue changes).

Classic presentation

A medial groin bulge in an older man, usually broad-necked, easily reducible, and rarely descending into the scrotum.

High-yield PANCE pearls

  • Hesselbach triangle boundaries: rectus (medial), inferior epigastrics (lateral), inguinal ligament (inferior).
  • Direct hernias go through the triangle (medial to the inferior epigastrics).

Imaging anatomy

CT

Shows a direct hernia medial to the inferior epigastric vessels.

Ultrasound

Dynamic groin ultrasound shows a sac bulging medial to the inferior epigastric vessels on Valsalva.

Physical exam

Surface landmarks

Lies medial to the midpoint of the inguinal ligament and just lateral to the rectus sheath, above the pubic tubercle.

Palpation

See the groin hernia examination on inguinal canal.

Self-quiz

Q1.

Which structure forms the lateral boundary of the inguinal (Hesselbach) triangle?

Show answer

C

The inferior epigastric vessels are lateral, rectus abdominis medial, and the inguinal ligament inferior.

Q2.

A hernia passing through the inguinal triangle is classified as which type?

Show answer

B

The inguinal triangle is the site of direct inguinal hernias, medial to the inferior epigastric vessels.

Q3.

Which layer is weak in a direct inguinal hernia?

Show answer

B

The floor of the triangle is the transversalis fascia (posterior wall of the inguinal canal); its weakness allows direct herniation.

Q4.

Which structure forms the medial boundary of the inguinal (Hesselbach) triangle?

Show answer

C

"RIP": Rectus abdominis (lateral border) is medial, the Inferior epigastric vessels are lateral, and Poupart (inguinal) ligament is inferior.

Q5.

Compared with femoral hernias, what is characteristic of direct inguinal hernias?

Show answer

E

Direct hernias are acquired, typically in older men, broad-necked and easily reducible, and rarely enter the scrotum, so strangulation is less likely. Femoral hernias (below the ligament, more common in women) have the highest strangulation risk; a patent processus vaginalis underlies indirect hernias.

Flashcards

See also