Direct inguinal hernias

[Lothric]

Hey,

What layers is a direct inguinal hernia covered with? An indirect one is covered by all 3 layers of spermatic fascia which makes sense considering the indirect hernias penetrate the internal and external inguinal rings and head towards scrotum.

But the direct ones should also do the above. They bulge through the abdominal wall and go through the external inguinal ring. Between the abdominal wall and external inguinal ring are structures that should yield all the components of the spermatic fascia.

What am I missing?

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[Muaad.Atef]

Good question ,,,
I think it's possible to say that Direct hernia would have all 3 layers. however, unlike the Indirect inguinal hernia, the Direct inguinal hernia DOES NOT go thru the spermatic cord instead its parallel to it .
and since it's not going thru the inguinal Canal except for the very end when it protrude thru the external ring , it doesn't get the coverings which surrounds the canal ( internal spermatic and cremasteric fascia and muscle ) but Only the external spermatic fascia which is in close proximity with the external ring
another way to look explain this would be to say that Direct inguinal hernia Pierce thru the layers till it reaches the external spermatic fascia and hence it's only covered by it .

 

[arcus]

Hey,

What layers is a direct inguinal hernia covered with? An indirect one is covered by all 3 layers of spermatic fascia which makes sense considering the indirect hernias penetrate the internal and external inguinal rings and head towards scrotum.

But the direct ones should also do NOT the above. They bulge through the abdominal wall and go through the external inguinal ring. Between the abdominal wall and external inguinal ring are structures that should yield all the components of the spermatic fascia.

What am I missing?

The Direct ones do NOT do the above (Indirect).

It is very easy to confuse these because it is a subtle term that differentiates them: Inguinal triangle / weak abdominal fascia vs inguinal canal / spermatic fascia.

The Direct Hernias involve the Inguinal Triangle which includes rectus abdominis muscle, the inferior epigastric artery, and the inguinal ligament. They rarely involve the scrotum

The Indirect Hernias involve the Inguinal Ring, Inguinal Canal and Scrotum

Direct inguinal hernias pass through the inguinal triangle (see #2, #10, and #11), which is an area of weak fascia. They almost never go into the scrotum. Both the superficial inguinal ring and the inherent weakness of abdominal wall lateral to the falx inguinalis make this area susceptible to hernias.

Indirect inguinal hernias start at deep inguinal ring, pass down inguinal canal, through superficial ring, and, in the male, usually descend into scrotum along with the spermatic cord. In the female they travel along the round ligament.

Dissector Answers - Inguinal Region
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[Lothric]

Hey,

Reviving this thread as I do have a question.

Am I correct in saying that the reason why a direct inguinal hernia is not covered by all layers of spermatic fascia is because as the hernia occurs from internal to more external layers there are some layers that simply will not be penetrated in such a way that gives the hernia any additional coverings. In other words, there are some openings in some layers that the hernia just goes through without interacting with the tissue. However, it so happens to be that at the external inguinal ring the direct inguinal hernia bulges through the aponeurosis of external oblique muscle so that it gets covered by the external spermatic fascia that this tissue gives rise to.

Correct?