Question about direct inguinal hernia

[Phloston]

Anatomy is one of my weaker areas so I need a bit of help visualizing this here...

FA2012, on p. 345, says direct inguinal hernias are "covered by external spermatic fascia."

Kaplan QBank says "direct inguinal hernias enter the inguinal canal by tearing through the posterior wall of that structure, the transversalis fascia."

I'm a bit confused here because doesn't the transversalis fascia give rise to the internal, not external, spermatic fascia?

Or am I missing something?

Once again, I'd appreciate anyone's anatomy help here.

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[withrye]

If you tear through the transversalis fascia, what is the next layer of fascia you meet? External spermatic.

They're just saying that once you've punched through one layer, the next most superficial layer is your new covering.

 

[Phloston]

But going from deep to superficial, wouldn't you hit cremasteric fascia before getting to external spermatic fascia?

 

[Chirurg]

But going from deep to superficial, wouldn't you hit cremasteric fascia before getting to external spermatic fascia?

you are confusing indirect with direct, I think.
indirect follows the descend of the testis and is covered by all three fascias (transversalis fascia/internal spermatic fascia, cremesteric fascia and external spermatic fascia).
direct inguinal hernia makes its own path, tears through the transversalis fascia, tears through the transversus abdminus and internal oblique fascia, it is only covered by the external spermatic fascia. you could say it sits inbetween the cremesteric fascia and external spermatic fascia, if that makes sense.

 

[Chirurg]

If you tear through the transversalis fascia, what is the next layer of fascia you meet? External spermatic.

They're just saying that once you've punched through one layer, the next most superficial layer is your new covering.

as I mentioned above, there are actually two more layers inbetween, before it is covered by external spermatic fascia.

 

[Phloston]

I don't have any confusion about indirect hernias. I'm aware that they are covered by all three layers.

The point I'm trying to make is that the only way both Kaplan QBank and FA could both be correct is if the direct hernia first "captures" the external spermatic fascia, and then instead of also bending/capturing the cremasteric and internal spermatic fascia convexly as it moves inferiorly, it pierces through both of them.

The confusion is because Kaplan only bothered mentioning breaking through the internal, but not the cremasteric, fascia.

I'm ~50% through the QBank at this point, and I'm actually not very impressed by the explanations, which I had heard were supposed to be so stellar.

 

[Belleza156]

http://m.youtube.com/watch?v=wAzXSqGybvEh