Direct indirect hernia question

[voicesinmyhead]

Physical exam reveals a soft reducible palpable mass in the supra pubic region with positive bowel sounds. When pressure is applied to the superficial inguinal ring, the mass protrudes when the patient is asked to cough. However when pressure is applied to the deep inguinal ring, mass does not protrude when the patient is asked to cough.

What kind of hernia is this?

Ans says direct

But shouldnt this be indirect, as the mass does not protrude when pressure is applied to the deep inguinal ring?

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[thehundredthone]

You're right. There's an error in that write up. Typically, the ring occlusion test is described by applying pressure only to the deep ring (after fully reducing the hernia), and the protrusion of a mass from the superficial ring on coughing indicates a direct hernia. (and the lack thereof, an indirect hernia)

 

[Transposony]

It's an Indirect hernia..............

 

[seminoma]

Can someone explain the test interpretation? I understand that indirect = thru deep and superficial ring and direct = superficial only. Just not sure how the test results work.

 

[thehundredthone]

That's exactly how it works. You reduce the hernia completely, then occlude the deep ring and ask the patient to cough. An indirect hernia will not protrude because the ring through which it first leaves the abdominal cavity (the deep ring) is occluded. A direct hernia will protrude because the ring through which it leaves the abdominal cavity (the superficial ring) is unoccluded.

 

[seminoma]

That's exactly how it works. You reduce the hernia completely, then occlude the deep ring and ask the patient to cough. An indirect hernia will not protrude because the ring through which it first leaves the abdominal cavity (the deep ring) is occluded. A direct hernia will protrude because the ring through which it leaves the abdominal cavity (the superficial ring) is unoccluded.

Thanks! I didn't realize "pressure on the ring" meant "occlude" the ring. Seems obvious now though, haha.