A 54-year-old construction worker with no significant past medical history presents to the physician’s office with complaints of right inguinal pain. The patient reports that his pain gradually worsens during the day and is worst at night. It is relieved almost completely when he lies down. Physical examination is remarkable for a bulge in the right inguinal region. The patient is diagnosed with a direct inguinal hernia bulging from the Hasselbach’s triangle. Which anatomic structure most likely defines the medial aspect of the patient’s hernia?
- Inguinal ligament
- Rectus abdominis muscle
- Inferior epigastric artery
- Inferior epigastric vein
- Femoral vein
Ans:
The patient presents with symptoms typical of direct inguinal hernia. Direct hernias bulge through the external superficial inguinal ring and occur secondary to abdominal wall weakness that occurs with old age. Direct hernias are most commonly present in the Hasselbach’s triangle, a unique region that lies low in the posterior aspect of the anterior abdomen delineated medially by the rectus abdominis muscle, inferiorly by the inguinal ligament, and laterally by the inferior epigastric vein and artery. In contrast, indirect inguinal hernias are common at young age; they occur due to the persistence of the processus vaginalis. Patients present with a bulge protruding from the internal deep inguinal ring.