Etiology

All abdominal hernias occur through a defect in the transversalis fascia.4 Indirect inguinal hernias are a result of a patent processus vaginalis. The processus vaginalis is formed by peritoneum that protruded through the deep inguinal ring during the descent of the testes in men and the course of the ovary and round ligament in women. Normally the processus vaginalis obliterates and failure to do so results in an indirect inguinal hernia.3 Indirect hernias are more common on the right, presumably due to the later descent of the right testicle.5

Direct inguinal hernias are more common in the latter third of life. They occur through an attenuated transversus abdominus muscle and the transversalis fascia. Hernias through Hesselbach's triangle (bounded medially by the lateral border of the rectus sheath, laterally by the inferior epigastric vessels, and inferiorly by the inguinal ligament) are considered direct hernias. Indirect hernias occur lateral to Hasselbach's triangle.

Femoral hernias occur through the femoral canal (bounded anteriorly by the inguinal ligament, medially by the lacunar ligament, posteriorly by Cooper's ligament and laterally by the femoral vein). The female pelvis is broad and flat resulting in increased risk for femoral hernias.

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