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Groin hernias
Indirect, direct and femoral hernias — the route each takes, where it sits relative to the landmarks, and who gets it.
| Hernia | Route | Relation to landmarks | Typical patient | Clinical points |
|---|---|---|---|---|
| Indirect inguinal | Through the deep ring and along the inguinal canal, often via a patent processus vaginalis; can descend into the scrotum | Lateral to the inferior epigastric vessels; above the inguinal ligament | Congenital; the most common hernia in both sexes and in children | In infants, an intermittent groin or scrotal swelling while crying |
| Direct inguinal | Through a weak posterior wall (transversalis fascia) in the inguinal (Hesselbach) triangle | Medial to the inferior epigastric vessels; above the inguinal ligament | Acquired; older men | Broad-necked, easily reducible, rarely enters the scrotum; lower strangulation risk than indirect or femoral hernias |
| Femoral | Through the femoral ring into the femoral canal | Below the inguinal ligament and medial to the femoral vein; the bulge lies below and lateral to the pubic tubercle | More common in women | Highest risk of incarceration and strangulation (narrow, rigid ring), so repair is recommended |
Hesselbach triangle (RIP): Rectus abdominis medially, Inferior epigastric vessels laterally, Poupart (inguinal) ligament inferiorly.
Dynamic ultrasound with Valsalva is first-line imaging for an equivocal groin bulge: it locates the sac relative to the inferior epigastric vessels and picks up a femoral hernia below the ligament.
A tender, irreducible hernia with erythema or bowel obstruction (incarcerated or strangulated) needs emergency surgery.