Description
A hernia is the protrusion of an organ, fatty tissue, or peritoneal sac through a weakness or opening in the wall that normally contains it.
Basic anatomy
A typical abdominal hernia has:
Hernial ring/defect: opening in the muscle or fascia
Sac: outpouching of the peritoneum, with a neck, body, and fundus
Contents: commonly preperitoneal fat, omentum, or intestine
Coverings: layers of abdominal wall carried outward around the sac
Inguinal hernia anatomy
The inguinal canal lies just above the inguinal ligament and runs from the deep inguinal ring to the superficial inguinal ring. It contains the spermatic cord in males and the round ligament in females.
Indirect inguinal hernia: enters through the deep ring, passes through the inguinal canal, and may descend into the scrotum. It lies lateral to the inferior epigastric vessels.
Direct inguinal hernia: pushes through the weakened posterior wall of the canal in Hesselbach’s triangle. It lies medial to the inferior epigastric vessels. NCBI anatomy reference
Hesselbach’s triangle is bounded by:
Medially: lateral border of rectus abdominis
Laterally: inferior epigastric vessels
Inferiorly: inguinal ligament
Other important types
Femoral: passes through the femoral canal, below the inguinal ligament and medial to the femoral vein; has a relatively high strangulation risk.
Umbilical: protrudes through or near the umbilical ring.
Epigastric: occurs through the linea alba above the umbilicus.
Incisional: develops through weakness in a previous surgical scar.
Hiatal: part of the stomach passes through the oesophageal opening of the diaphragm.
A hernia is reducible if its contents return to the cavity, incarcerated if trapped, and strangulated if its blood supply is compromised. Sudden severe pain, vomiting, tenderness, or a firm irreducible swelling requires urgent medical assessment.
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