Pantaloon Hernia
A combined direct and indirect inguinal hernia occurring simultaneously on the same side is called a "pantaloon hernia" (also known as a "mixed" or "combined" inguinal hernia). 1, 2, 3
Anatomical Definition
- A pantaloon hernia consists of both direct and indirect hernial sacs that straddle the inferior epigastric vessels, creating a characteristic appearance resembling a pair of pants 1
- The two hernial components are initially separated by the "septum inguinalis"—an anatomical structure composed anteriorly of fibers from the internal oblique and transverse muscles, and posteriorly by the inferior epigastric vessels 1
- This septum represents the boundary between the internal ring (where indirect hernias occur) and Hesselbach's triangle (where direct hernias occur) 1
Progression to Combined Hernia
- When the septum inguinalis undergoes progressive structural damage and complete disruption, the two distinct hernial sacs merge into a single large hernial protrusion—this advanced stage is specifically termed a "combined hernia" 1
- The septal tissue shows chronic compressive damage both macroscopically and microscopically before complete disruption occurs 1
Clinical Significance
- Pantaloon hernias comprised 11% (156 of 1411 cases) in one large surgical series, indicating they are not uncommon 3
- These hernias can occur alongside other hernial defects, such as femoral hernias, creating even more complex presentations 2
- The classification allows surgeons to recognize the increased complexity and plan appropriate surgical repair strategies 4, 3