Table of Contents
An inguinal hernia is the protrusion of abdominal contents through the inguinal canal.

Anatomy
- Inguinal ligament = ASIS to pubic tubercle
- Inguinal canal = deep inguinal ring to superficial inguinal ring
- Inguinal ring positions
- Deep inguinal ring (start of inguinal canal) = midpoint of the inguinal ligament
- Superficial inguinal ring (end of inguinal canal) = superior to the pubic tubercle
- Borders of the inguinal canal MALT
- Muscle (internal oblique) – ROOF
- Aponeurosis (external oblique) – ANTERIOR
- Ligament (inguinal ligament) – FLOOR
- Tendon (transversalis fascia) – POSTERIOR
- Contents
- Males: spermatic cord and ilioinguinal nerve
- Inguinal ring positions
Spermatic cord contains:
- 3 arteries: testicular artery, artery to vas deferens, cremasteric artery
- 3 nerves: genitofemoral nerve, autonomic nerves, ilioinguinal nerve (outside cord)
- 3 other structures: vas deferens, pampiniform plexus of veins, lymphatic vessels
- Females: round ligament of the uterus and ilioinguinal nerve
- Points to remember
- Midpoint of the inguinal ligament (midpoint between the ASIS and pubic tubercle) = deep inguinal ring position
- Mid-inguinal point (midpoint between the ASIS and pubic symphysis) = femoral artery position
Direct vs indirect inguinal hernia
- Direct inguinal hernia (40%)
- Herniated abdominal contents come directly out of abdomen in a straight line
- Penetrate through the superficial inguinal ring
- If reduced, cannot be controlled by applying pressure over the deep inguinal ring
- Indirect inguinal hernia (60%)
- Herniated abdominal contents run in the inguinal canal
- Penetrate through the deep inguinal ring
- Can go right the way down the canal into the scrotum in men (inguinal-scrotal hernia)
- May occur due to failure of the closure of the processus vaginalis
- If reduced, can be controlled by applying pressure over the deep inguinal ring
Inguinal hernia vs femoral hernia
- Femoral hernia is inferior and lateral to the pubic tubercle (through femoral canal) – more common in females
- Direct inguinal hernia is superior to the pubic tubercle (position of superficial inguinal ring) – more common in males
- Indirect inguinal hernia can occur anywhere between the deep inguinal ring and the scrotum
Hernia terminology
Reducible | Can be pushed back into the abdomen by applying pressure |
Irreducible | Cannot be pushed back into the abdomen by applying pressure |
Obstructed | Lumen if herniated part of bowel is compressed so contents cannot pass, causing obstructive symptoms |
Strangulated | Vasculature to herniated bowel is compressed, causing ischaemia |
Management
- Watch and wait: for small, asymptomatic hernias
- Open repair: for irreducible, obstructed or strangulated hernias
- Open/laparoscopic mesh repair: for large or symptomatic hernias