This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Comparison of direct and indirect inguinal hernia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The differentiation of a direct from indirect inguinal hernia is not vital; management is similar for both.

A direct inguinal hernia protrudes directly forwards when the patient stands up whereas the indirect hernia shows a more oblique route downwards towards the scrotum. A hernia which goes into the scrotum is always indirect. The direct hernia appears as a symmetric, circular swelling at the external ring, i.e. medial to the femoral artery, whereas the indirect hernia is seen as an elliptical swelling.

From the superficial ring, an indirect hernia reduces superiorly then superolaterally. A direct hernia reduces superiorly then posteriorly.

The reduced indirect hernia can be controlled by pressure over the internal ring, classically with a single finger, but a reducible, direct hernia cannot.

On standing, the direct hernias appears immediately whilst the indirect hernia takes time to reach its full size. Similarly, on lying down, direct hernias disappear immediately whilst there is a delay before the reducible indirect retracts fully. This is due to the relatively large orifice of the direct hernia compared to that of the indirect one. This also explains the greater propensity of the indirect hernia to strangulate and that its defect is not always palpable. For a direct hernia, the defect may be palpable superior to the pubic tubercle.

Direct hernias are always acquired and are rare in children. They are more common in males.

At operation, the direct hernia passes medially to the inferior epigastric vessels whilst the indirect hernia passes laterally to these.


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.