Inguinal herniae Figs 223 and 521

• Indirect inguinal herniae: arise as a result of persistence of the processus vaginalis of the embryo. Abdominal contents bulge through the deep inguinal ring, into the canal, and eventually into the scrotum. This hernia can be controlled by digital pressure over the deep ring.

• Direct inguinal herniae: arise as a result of weakness in the posterior wall of the inguinal canal. This hernia cannot be controlled by digital pressure over the deep ring and only rarely does the hernia pass into the scrotum.

The clinical distinction between direct and indirect inguinal hernias can be difficult. At operation, however, the relation of the hernial neck to the inferior epigastric artery defines the hernia type, i.e. the neck of the sac of an indirect hernia lies lateral to the artery whereas that of a direct type always lies medial to it.

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