0:00

Okay, so we just looked at a case of

0:02

an indirect inguinal hernia, and let's

0:04

walk down this direct inguinal hernia.

0:06

Here we see some dilated loops of small bowel.

0:08

And then as we come down to the groin location,

0:11

that arrow is outlining the epigastric vessels.

0:13

It can be really small, hard to see.

0:16

You're going to see this hernia coming out

0:18

medially, oh, on both sides to that vessel.

0:22

Now if we go coronal, you'll also see that although

0:25

it comes medial, it'll also be a much more vertical

0:28

descent of the hernia sac as opposed to that oblique

0:31

descent of the hernia sac in the indirect hernia.

0:34

So a direct hernia frequently has this very direct,

0:37

inferiorly going descent, all medial

0:41

to the epigastric vasculature.

0:43

Let's look at these together.

0:45

Okay, so again, back to our

0:48

triangle that we love so much.

0:50

We have the indirect inguinal hernia coming out

0:53

lateral to the epigastric vasculature in that oblique

0:55

plane, as opposed to this very vertically oriented

0:58

direct inguinal hernia in the coronal plane here.

1:02

So you can

1:04

see the inguinal hernias and call them

1:06

direct or indirect, at least call them an

1:08

inguinal hernia and make sure that that's what

1:10

you're dealing with, not a femoral hernia.

1:12

Strangely, a lot of these are just fat

1:13

containing, and a lot of patients actually come

1:16

for imaging to look for fat-containing hernias.

1:18

So you do want to speak about these,

1:19

especially in the outpatient.

1:20

Here's a patient with both a direct inguinal

1:23

hernia and an indirect inguinal hernia.

1:26

You can see the indirect inguinal hernia is coming,

1:28

these are both fat containing, not bowel containing,

1:30

coming in that oblique fashion where the direct

1:33

inguinal hernia is coming more vertically.

1:35

This is actually referred to as the pantaloon hernia.

1:38

Um, and these can be a little bit more difficult

1:40

for the surgeons to repair, so they like to know

1:43

if there are both direct and indirect components.

1:47

So inguinal hernias,

1:48

indirect, direct.

1:49

Sometimes they cause obstruction.

1:51

Sometimes they're just bowel containing without

1:53

obstruction, and sometimes they're fat containing

1:55

and can be quite uncomfortable for patients.