PATHOPHYSIOLOGY

Inguinal Hernia

This is the most common form of hernia and refers to when bowel or fatty tissue
protrudes into the groin. This type of hernia mainly occurs in men. A painful dragging
sensation may be felt, as well as pain and swelling in the scrotum and testicles.

In cases of inguinal hernia, a loop of intestine protrudes through a hole in the abdominal
wall into the inguinal canal, which contains the spermatic cord. While a male fetus is in
the womb, the testes are formed in the abdomen and before birth; they descend into the
scrotum via the inguinal canal. The weakness that occurs in the abdominal wall may be
present at birth or may develop later on in life.
An indirect inguinal hernia is one that occurs as a congenital lesion. It occurs as a result
of the deep inguinal ring failing to close during embryogenesis after a testicle has
moved through it. Once bowel or other abdominal tissue moves into and enlarges the
empty space, a visible bulge forms and the hernia becomes clinically evident.

Direct hernias are acquired rather than congenital and usually occur in people aged 25
or older. This hernia occurs due to degeneration and fatty changes in the inguinal floor
or posterior wall in an area called the Hesselbach triangle. The majority of direct hernias
does not have a true peritoneal lining and do not contain intestine; they mainly contain
preperitoneal fat and occasionally bladder. A long-standing direct hernia that has
become large may extend into the scrotum and may also contain abdominal content or
intestine.