Relation of hernial sac to spermatic cord in direct inguinal hernia is
High-Yield Explanation
Ans. b (Sac is posterior to cord). (Ref. B & L, Surgery, 25th/pg. 70, 971)INGUINAL HERNIAS# Indirect inguinal hernia:- It is the remains of the processus vaginalis and therefore is congenital in origin.-It is more common than a direct inguinal hernia.- It is much more common in males than in females.- It is more common on the right side.- It is most common in children and young adults.- The hernial sac enters the inguinal canal through the deep inguinal ring and lateral to the inferior epigastric vessels.- An indirect inguinal hernial sac travels down the canal on anterolateral aspect of spermatic cord.- The neck of the sac is narrow.- The hernial sac may extend through the superficial inguinal- ring above and medial to the pubic tubercle. (Femoral hernia is located below and lateral to the pubic tubercle).- The hernial sac may extend down into the scrotum or labium majus.# Indirect inguinal hernia:- While a direct inguinal hernial sac comes out directly forwards through posterior wall of inguinal canal, Neck of indirect hernial sac is lateral to inferior epigastric vessels, while direct emerges medial to it.- An inguinal hernia can be differentiated from femoral by sac neck relation to medial end of inguinal ligament and pubic tubercle i.e. in inguinal hernia neck is above and medial while in femoral it is below and lateral to medial end of inguinal ligament and pubic tubercle.- So, direct hernia = sac is posterior, Indirect hernia = sac anterolateral.- Direct hernias do not often attain a large size or descend into scrotum.- In contrast to an indirect inguinal hernia, a direct inguinal hernia lies behind the spermatic cord.- As neck of the sac is wide, direct hernia s do not often strangulate.- A direct inguinal hernia is always acquired (Smoking, occupation that involve straining & heavy lifting & damage to ILIOINGUINAL NERVE)- Women practically never develop a direct inguinal hernia (It is common in old men with weak abdominal muscles and is rare in women).