Indirect inguinal hernias arise lateral and superior to the course of the inferior epigastric vessels, lateral to Hesselbach's triangle, and then protrude ...×ArticlesLogInCasesSignUpCoursesQuizDonateAbout×MenuSearchADVERTISEMENT:Radiopaediaisfreethankstooursupportersandadvertisers.BecomeaGoldSupporterandseenoads.ArticlesCasesCoursesLogInLoginSignup{"url":"/signup-modal-props.json?lang=us\u0026email="}ArticlesCasesCoursesQuizAboutRecentEditsGoad-freeSearchIndirectinguinalherniaDrSonamVadera◉andAssocProfFrankGaillard◉◈etal.Indirectinguinalhernias (alternativeplural:herniae),atypeofgroinherniation, arethemostcommontypeofabdominalhernia.Onthispage:Article:EpidemiologyPathologyTreatmentandprognosisDifferentialdiagnosisRelatedarticlesReferencesImages:CasesandfiguresEpidemiologyItisfivetimesmorecommonthanadirectinguinalhernia,andisseventimesmorefrequentinmales,duetothepersistenceoftheprocessusvaginalisduringtesticulardescent. Inchildren,thevastmajorityofinguinalherniasareindirect. PathologyIndirectinguinalherniasariselateralandsuperiortothecourseoftheinferiorepigastricvessels,lateraltoHesselbach'striangle,andthenprotrudethroughthedeeporinternalinguinalringintotheinguinalcanal.Anindirectherniaenterstheinguinalcanalatthedeepring,lateraltotheinferiorepigastricvessels.Itpassesinferomediallytoemergeviathesuperficialringand,iflargeenough,extendintothescrotum.Genderdifferencesmales:theyenterthecanalanteriortothespermaticcordandmayextendthroughtheexternalinguinalringintothescrotumfemales:theytendtofollowtheroundligamentintothelabiamajoraContentsContentsmayincludemesentericfat(mostcommon),peritonealfluid,smallbowelloops,mobilecolonsegments(sigmoid,cecum,appendix).Manyarelongstandingandasymptomatic,althoughthesheersizecanbecomeburdensome.TreatmentandprognosisComplicationsinclude:incarcerationthemostcommoncomplicationassociatedwithinguinalhernias,theincidencecouldbeashighas30%forinfantsyoungerthan2monthsstrangulationwithbowelischemiaandperforationintestinalobstructionDifferentialdia