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Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
A 23-year-old male is diagnosed with a direct inguinal hernia. The surgical Registrar intraoperatively asks you to define Hesselbach’s triangle. Hesselbach’s triangle is bounded medially by which anatomical structure?Lacunar ligamentInferior epigastric arteryFemoral arteryRectus abdominisInguinal ligament
H
Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Hesselbach Triangle Anatomical area bounded by the inferior epigastric artery, the margin of the rectus abdominis, and the inguinal ligament. First described by Franz Casper Hesselbach (1759–1816), professor of surgery at WÜrzburg in 1806.
Hernia and hydrocele
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
The deep inguinal ring is a defect in the transversalis fascia 1 cm above the midpoint of inguinal ligament, lateral to inferior epigastric vessels. The superficial inguinal ring is a defect in the aponeurosis of external oblique, located above and medial to the pubic tubercle. An indirect hernia passes through the deep inguinal ring and along the inguinal canal into the scrotum, while a direct hernia bulges through the posterior wall of the canal medial to the inferior epigastric artery through Hesselbach’s triangle. The boundaries of Hesselbach’s triangle are inferior epigastric artery (laterally), inguinal ligament (inferiorly) and lateral border of rectus abdominis (medially). An indirect hernia in a child is due to a patent processus vaginalis, which is a peritoneal diverticulum extending through the internal inguinal ring into the canal.
The Septum Inguinalis: A Clue to Hernia Genesis?
Published in Journal of Investigative Surgery, 2020
Giuseppe Amato,, Piergiorgio Calò,, Vito Rodolico,, Roberto Puleio,, Antonino Agrusa,, Leonardo Gulotta,, Luca Gordini,, Giorgio Romano,
The hernia variant consisting of 1 direct and 1 indirect protrusion, also called pantaloon hernia, provides interesting evidence in the study of the physiopathology of hernia disease. In such cases only a strip of tissue of the inguinal backwall, variable in width and thickness and herein referred to as the septum inguinalis, separates the 2 protrusions. From the anterior side, starting from the medial aspect of the internal ring, this anatomical complex converges into the lateral portion of the fossa inguinalis media as seen in Figure 1A, B. Posteriorly, this muscular tissue strip is tightly connected to the sheath containing the inferior epigastric vessels (Figure 2A, B). The septum separates Hesselbach’s triangle from the internal inguinal ring and, in effect, represents the last barrier that impedes the complete disbanding of the inguinal floor as seen in combined hernia where the entire inguinal backwall is deficient [10]. Following the cited report, the present research is aimed to deepen this subject, portraying a complete spectrum of information to highlight the progressive worsening of the septal structure that divides the 2 protrusions. This would envisage that, thanks to the orthostatic posture typical of the human being, in predisposed individuals the vector forces of the visceral pressure leads the abdominal content to impact against the inguinal floor. Thus, causing chronic compressive injuries to the inguinal backwall. The degeneration first affects the more delicate muscular structure of the anterior aspect of the inguinal floor leading to degeneration of the lateral aspect of the medial fossa and the medial portion of the internal ring, still separated by the septal diaphragm. This moment characterizes the phase of pantaloon hernia. The dissolution of the muscular coverage of the septum, away from the hernia edge, should demonstrate that the septal diaphragm is not subject to direct pressure from within the hernia sacs it separates, but rather from the general (posterior) impact of the non-herniated abdominal viscera. At this stage, the epigastric vessels, wrapped by a robust covering sheath, resist longer to the compressive harm. Nevertheless, by time, the degeneration also involves the vascular structures until its complete disbanding. As a result, the wide-ranging dissolution of the inguinal backwall finally opens the doors to combined hernia. This should mean that pantaloon hernia is the precursor of combined hernia with complete backwall defect. All these functional modifications of the inguinal anatomy are macroscopically clearly visible and should be properly evidenced during hernia repair procedures.