From the Research
The answer is B. Direct inguinal hernia, as it occurs above and medial to the pubic tubercle, protruding directly through a weakness in the posterior wall of the inguinal canal, specifically through Hesselbach's triangle. This triangle is bounded by the inferior epigastric vessels laterally, the rectus abdominis muscle medially, and the inguinal ligament inferiorly. Direct hernias develop due to weakness in the transversalis fascia, often resulting from increased intra-abdominal pressure over time. They are more common in older adults and are typically acquired rather than congenital. In contrast, indirect inguinal hernias emerge lateral to the inferior epigastric vessels and follow the path of the spermatic cord through the internal inguinal ring. Femoral hernias occur below and lateral to the pubic tubercle, while obturator hernias protrude through the obturator foramen in the pelvis, as described in cases of strangulated obturator hernia 1, 2, 3. The diagnosis of obturator hernia is often delayed due to non-specific symptoms, and computed tomography (CT) scan is the most favored diagnostic imaging method 4. However, the location of a direct inguinal hernia is distinct and can be identified by its position above and medial to the pubic tubercle. Some key points to consider when evaluating hernia types include:
- The location of the hernia in relation to the pubic tubercle
- The presence of specific symptoms, such as obturator neuralgia or the Howship-Romberg sign, which may indicate an obturator hernia 4
- The use of diagnostic imaging, such as CT scan, to confirm the diagnosis of an obturator hernia 1, 3
- The importance of prompt surgical intervention to prevent severe complications and reduce associated morbidity and mortality 1, 2, 3.