Difference between indirect inguinal hernia and direct hernia

Hernia is a disease that occurs more frequently in the elderly. Its main symptoms are abdominal pain and cold body. Hernia is a common disease in clinical practice, and the difference between inguinal oblique hernia and direct hernia is an important point of knowledge. Now let’s get to know these two types of hernias and list the differences between inguinal oblique hernia and direct hernia.

Direct hernia: When abdominal organs and tissues protrude through the Hesselbach triangle on the inner side of the inferior epigastric artery, it is a direct inguinal hernia. In the elderly and weak, the abdominal wall muscles, aponeurosis, and fascia degenerate, and the strength of the abdominal wall decreases. Direct hernia may occur due to the increased intra-abdominal pressure. A huge indirect hernia may significantly weaken or even eliminate the posterior wall of the inguinal canal and may also lead to a direct hernia. Direct hernia is more common in middle-aged and elderly people who are weak. Direct hernia generally has no obvious symptoms, only a slight soreness and swelling when the hernia protrudes. Because the hernia directly emerges from the Hell's triangle, the hernia ring, which is the weak area of ​​the Hell's triangle, is relatively wide, without an obvious hernia sac neck, and incarceration rarely occurs. During physical examination, the patient is asked to stand up, and the hernia is found to protrude above and outside the pubic tubercle, forming a hemispherical bulge. After the hernia is retracted, pressing the Heilongjiang triangle with your hand can prevent the hernia from coming back.

Oblique hernia : Protrusion of abdominal organs or tissues through the inguinal canal is called inguinal oblique hernia, which accounts for about 90% of inguinal hernias and is the most common extraabdominal hernia. The appearance of a reducible mass at the external ring of the inguinal canal is the most important clinical manifestation. Initially, the mass protrudes obliquely along the inguinal canal toward the external ring when standing, walking or coughing for a long time. Later, the mass gradually increases in size and extends into the scrotum. The mass is narrow at the top and wide at the bottom, shaped like a pear, and it seems to have a handle extending into the inguinal canal. There is a feeling of falling or mild soreness when the lump protrudes. During the examination, the patient lies supine with the affected hip flexed and adducted and the groin relaxed. The lump can be retracted by gently pressing it in an upward and outward direction along the inguinal canal. If you press the inner ring 2 cm above the midpoint of the inguinal ligament and ask the patient to stand and cough, the lump can be prevented from protruding. When the pressing fingers are removed, the lump will return. If it is an incomplete oblique hernia and the hernia contents do not protrude from the external ring, you can insert your fingers into the opening of the external ring. The patient feels a shock when coughing.

Inguinal oblique hernia is different from direct hernia in many aspects, mainly in the following aspects:

1. Age of onset: Oblique hernia is more common in children and young adults; direct hernia is more common in the elderly.

2. Hernia protrusion route: Indirect hernia protrudes through the inguinal canal and can enter the scrotum; direct hernia protrudes through the direct hernia triangle and does not enter the scrotum.

3. Appearance of hernia mass: The hernia mass of indirect hernia is oval or pear-shaped, with a pedicle-shaped upper part; the hernia mass of direct hernia is hemispherical with a wider base.

4. After retracting the hernial mass, press the hernial ring: indirect hernia may no longer protrude; the hernial mass of direct hernia may still protrude.

5. The relationship between the spermatic cord and the hernia sac: When an indirect hernia occurs, the spermatic cord is behind the hernia sac; in a direct hernia, the spermatic cord is in the front and outside of the hernia sac.

6. The relationship between the hernia sac neck and the inferior epigastric artery: the hernia sac neck of indirect hernia is on the outside of the inferior epigastric artery; the hernia sac neck of direct hernia is on the inside of the inferior epigastric artery.

7. Chance of incarceration: Indirect hernias have a higher chance of incarceration; direct hernias have a very low chance of incarceration.

In clinical practice, we ultimately determine whether a patient has an indirect hernia or a direct hernia, just like a tumor is removed and sent for pathological biopsy. We still have to draw a conclusion by observing the location of the hernia gap during the operation.