In human anatomy, the inguinal triangle is a region of the abdominal wall.

It is also known by the eponym Hesselbach's triangle, after Franz Kaspar Hesselbach.[1]

Direct hernias are always acquired and therefore unusual in the young. They typically affect middle-aged or elderly patients. A direct inguinal hernia occurs because of degeneration and fatty changes in the aponeurosis of the transversalis fascia in the Hesselbach triangle area. The Hesselbach triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries and medially by the lateral b t is
defined by the following structures:[2] Rectus abdominis muscle (medially) Inferior epigastric vessels (superior and laterally). Inguinal ligament, sometimes referred to as Poupart's ligament (inferiorly) This can be remembered by the mnemonic RIP (as Direct inguinal hernias rip directly through the abdominal wall.) [edit]Clinical

significance

The inguinal triangle contains a depression referred to as the medial inguinal fossa, through which direct inguinal hernias protrude through the abdominalwall.[3]

order of rectus abdominus. Because of the wide neck of a direct hernia, it rarely strangulates. They are very common
(lifetime risk 27% for men, 3% for women[1]), Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring.

[edit]Classification Relationship to inferior epigastric vessels Covered byinternal spermatic fascia?

Type

Description

Usual onset

indirect inguinal hernia

protrudes through the inguinal ring and is ultimately the result of the failure of Lateral embryonic closure of the internal inguinal ring after the testicle passes through it

Yes

Congenit al

direct inguinal hernia

enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)

Medial

No

Adult

An inguinal hernia is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the grointhe area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time. Direct inguinal hernia. Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia:

sudden twists, pulls, or muscle strains lifting heavy objects straining on the toilet because of constipation weight gain

chronic coughing
Direct hernia A direct inguinal hernia usually occurs due to a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon.5 Incarcerated hernia: An incarcerated hernia is no longer reducible. The vascular supply of the bowel is not compromised. Bowel obstruction is common.

Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.

HERNIA A HERNIA is a protrusion of an internal organ or part of an organ through a tear, hole or defect in the wall of a body cavity (ie the abdominal wall muscle). A hernia may be likened to a failure in the sidewall of a pneumatic tire {Photo}. The tire's inner tube behaves like the organ and the sidewall like the body cavity wall providing the restraint.

Hernias may be present at birth, or be acquired later in life after repetitive heavy strain or injury to this abdominal wall muscle. Hernias may occur commonly in such areas as the lower abdomen or groin areas (Inguinal Hernia), at the region around the navel (Umbilical Hernia), or even through a prior surgical incision (Incisional Hernia). Hernias can re-occur in an area of a previous hernia repair (Recurrent Hernia). But Hernias can and do occur anywhere on the abdominal wall, and are given other various names such Femoral, Epigastric, Spigelian or Sports Hernia. The basic problem remains the same, the muscle container of the abdominal wall no longer holds the contents safely and securely in place. As pressure inside the abdomen pushes the abdominal contents through this defect, a bulge is created, and pain, burning or aching are experienced. These symptoms gradually increase in intensity with time as the hernia gradually enlarges, stretching surrounding tissue and irritating local nerve pain fibers. Surgery is recommended to alleviate symptoms and prevent the hernia from becoming caught (Incarcerated) in the muscle tear or defect and having its blood supply damaged (Strangulated). DIRECT HERNIA (Acquired) These hernias develop as a progressive weakness in an area called the Inguinal Floor (or in the medial triangle of the Myopectineal Orifice). With increase intra-abdominal pressure during activity, lifting, sports or injury, a weakness may develop in the fascial covering of the abdominal wall in this region. This weakness gradually, or at times rapidly, breaks through causing a true Hernia. The bulge gradually enlarges and causes pain as intra-abdominal contents push through the defect.

. INCARCERATION The trapping of abdominal contents within the Hernia itself. The bulge cannot be reduced or pushed back. This could mean that intestine from within the abdomen is trapped in the hernia and the risk of injury to abdominal contents and intestine is increased. Surgical release and hernia repair are emergently necessary to avoid injury to the intestine.

Direct hernias are always acquired and therefore unusual in the young. They typically affect middle-aged or elderly patients. A direct inguinal hernia occurs because of

degeneration and fatty changes in the aponeurosis of the transversalis fascia in the Hesselbach triangle area. The Hesselbach triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries and medially by the lateral border of rectus abdominus. Because of the wide neck of a direct hernia, it rarely strangulates. Strangulation is more common with indirect hernia, which has a narrow neck. As segments of the intestine prolapse through the defect in the anterior abdominal wall, they cause sequestration of fluid within the lumen of the herniated bowel. This initially impairs the lymphatic and venous drainage, which further compounds the swelling, and over time the arterial supply becomes involved. The increased intraluminal pressure causes the wall of the affected segment to become congested, which leads to extravasations of blood into the hernia sac. The normal pinkish and shining color of the bowel wall is lost and replaced with a dull congested bowel segment, followed by loss of tone within the bowel wall. This favors bacterial proliferation and subsequent infection of the blood-stained fluid in the hernia sac. Gangrene ensues and, if left untreated, perforation occurs. Peritonitis occurs initially within the sac and then spreads to the peritoneal cavity.
Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring

enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)

Media Adul No l t

Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. The inability to "reduce", or place the bulge back into the abdomen usually means the hernia is 'incarcerated' which is a surgical emergency.

What is inguinal hernia? An inguinal hernia is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the grointhe area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time. Direct inguinal hernia. Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of

continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia:

sudden twists, pulls, or muscle strains lifting heavy objects straining on the toilet because of constipation weight gain chronic coughing

What are the symptoms of inguinal hernia? Symptoms of inguinal hernia include

a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum discomfort or sharp painespecially when straining, lifting, or exercisingthat improves when resting a feeling of weakness or pressure in the groin a burning, gurgling, or aching feeling at the bulge

What are incarcerated and strangulated inguinal hernias? An incarcerated inguinal hernia is a hernia that becomes stuck in the groin or scrotum and cannot be massaged back into the abdomen. An incarcerated hernia is caused by swelling
Direct hernia A direct inguinal hernia usually occurs due to a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon.5 Incarcerated hernia: An incarcerated hernia is no longer reducible. The vascular supply of the bowel is not compromised. Bowel obstruction is common. Incarcerated hernia o o o Painful enlargement of a previous hernia or defect Cannot be manipulated (either spontaneously or manually) through the fascial defect Nausea, vomiting, and symptoms of bowel obstruction (possible)

Causes
Any condition that increases the pressure in the intra-abdominal cavity may contribute to the formation of a hernia, including the following: Marked obesity Heavy lifting Coughing Straining with defecation or urination

Ascites Peritoneal dialysis Ventriculoperitoneal shunt Chronic obstructive pulmonary disease (COPD) Family history of hernias14

A direct hernia affects both sexes. The intestinal loop forms a swelling in the inner part of the fold of the groin. In an incarcenated hernia the protrusion can't be put back into place without surgery because some surrounding tissues or parts have grown together.
Causes and Risk Factors of Inguinal Hernia

Inguinal hernias are usually caused by a congenital defect which occurs as a weakness in the inguinal canal manifesting after injury, pregnancy or aging. Inguinal hernias may appear following surgery or after heavy lifting, birthing a child, exercising, persistent coughing, straining while urinating or defecating or by gaining a lot of weight.
Symptoms of Inguinal Hernia

Frequently hernias produce no symptoms. However, some people may experience the following symptoms:

A lump or swelling in the groin A sudden pain into the scrotum Abdominal discomfort A heavy feeling in the groin Pain in the groin while standing or moving
In some cases inguinal hernia causes could not be pinpointed due to a lack of apparent cause, and in some other cases the causes were identified as intense abdominal pressure and a weak region on the abdominal wall that was existing beforehand or either of the two causes. This pre existing weak spot in men is often found by the side of the inguinal canal.