Tuesday, May 4, 2010

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Hesselbach's triangle

A direct hernia passes through the Hesselbach's triangle while an indirect one passes lateral to it.

This area is the weakest because the abdominal here consists only of the transversalis fascia covered by the external oblique aponeurosis.

As shown by the figure below:

Inferiorly : Inguinal ligament
Laterally : Inferior epigastric artery
Medially : Lateral border of rectus abdominis.

To confirm this we can do a ring occlusion test whereby the deep inguinal ring is occluded at 1.25cm above the midpoint of the inguinal ligament after reducing the hernia. Now we can ask the patient to cough or stand up. If the hernia is seen even though the deep ring is occluded it means that the hernia is of the direct type.

First published on : 4 May 2010
Last reviewed on : 2 May 2020


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