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Old 11-21-2012
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Arrow Billy Step 1 Questions # 91

A 76-year-old man is scheduled to undergo repair of an abdominal hernia that is easily reduced by pushing the abdominal contents back through the external ring. During repair, the surgeon sees that the hernial sac protrudes
from the abdominal wall superior to the inguinal ligament and medial to the inferior epigastric vessels. Which of the following types of hernia does this patient have?


(A) Diaphragmatic hernia
(B) Direct inguinal hernia
(C) Femoral hernia
(D) Hiatal hernia
(E) Indirect inguinal hernia
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Old 11-21-2012
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Default my answer :)

(B) Direct inguinal hernia
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Originally Posted by billy View Post
A 76-year-old man is scheduled to undergo repair of an abdominal hernia that is easily reduced by pushing the abdominal contents back through the external ring. During repair, the surgeon sees that the hernial sac protrudes
from the abdominal wall superior to the inguinal ligament and medial to the inferior epigastric vessels. Which of the following types of hernia does this patient have?


(A) Diaphragmatic hernia
(B) Direct inguinal hernia
(C) Femoral hernia
(D) Hiatal hernia
(E) Indirect inguinal hernia
Obviously neck of the hernial sac medial to the inferior epigastric vessels i.e. through the weak posterior wall of inguinal canal which is triangle of hasselbach is Direct inguinal hernia.

Whereas when the neck of hernial sac lies lateral to the inferior epigastric vessels i.e. passing through the deep inguinal ring will be Indirect inguinal hernia.
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Old 11-21-2012
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Direct Inguinal hernia
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Old 11-21-2012
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Default Answer B

B. Direct inguinal hernia
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Default B

(B) Direct inguinal hernia
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(B) Direct inguinal hernia
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Old 11-21-2012
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(B) Direct inguinal hernia
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Correct Answer B is correct

Direct inguinal hernias protrude directly through the abdominal wall in Hesselbach’s triangle, which is bordered by the inguinal ligament, rectus abdominis muscle, and inferior epigastric vessels. Remember that the issue of direct versus indirect has nothing to do with whether or not the hernia enters the scrotum through the external ring, as both direct and indirect hernias can do this. Direct versus indirect distinguishes where the hernia enters the inguinal canal, either through the internal ring (indirect) or straight through the abdominal wall (for direct hernias, think directly through the wall). In this case, the abdominal contents pierced through the abdominal wall and through the external inguinal ring. Direct hernias are often discovered in older patients, as the hernia is a result of pressure and tension exerted over time that eventually leads the abdominal wall to give way. Direct hernias are less common and have less risk of strangulation than indirect hernias.
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