Expansion
Indirect passes lateral to the inferior epigastric vessels; direct pushes through medial to them
Expansion
MDs don’t LIe, Medial = Direct, Lateral = Indirect.
Indirect
- Passes through the deep ring, lateral to the inferior epigastric vessels
- Travels within the spermatic cord and its coverings
- Congenital, from a patent processus vaginalis
- Commoner overall, and in young men; may reach the scrotum
Direct
- Pushes forwards through the weak posterior wall in Hesselbach’s triangle, medial to the vessels
- Lies outside the cord coverings
- Acquired, from weakness of the transversalis fascia
- Older patients; rarely enters the scrotum
Both emerge above and medial to the pubic tubercle, which is what distinguishes them as a group from a femoral hernia, which appears below and lateral to it.