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An inguinal hernia (pronounced /ˈɪŋɡwɨnəl ˈhɜrniə/) is a protrusion of abdominal-cavity contents through the inguinal canal. They are very common (lifetime risk 27% for men, 3% for women), and their repair is one of the most frequently performed surgical operations.
There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the superficial inguinal ring. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.
In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall for the intestines to protrude through.
Signs and symptoms
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. The inability to "reduce", or place the bulge back into the abdomen usually means the hernia is 'incarcerated' which requires surgery to correct.
Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).