Inguinal hernia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]


Directed inguinal hernia is caused by protrusion through Hesselbach triangle, passes medial to inferior epigastric vessels. Indirected inguinal hernia is caused by passes through internal inguinal ring, traverses inguinal canal to external ring, and may extend into scrotum in males and labia majora in females.



  • It is understood that indirect inguinal hernia is caused by:[1][2]
    • Passes through internal inguinal ring, traverses inguinal canal to external ring
    • May extend into scrotum in males and labia major in females
    • Passes lateral to inferior epigastric vessels and has an oblique inferior course
    • Considered a congenital defect and associated with a patent processus vaginalis
  • It is understood that directed inguinal hernia is caused by:
    • Protrusion through Hesselbach triangle
    • Generally does not extend into scrotum
    • Passes medial to inferior epigastric vessels
    • Considered an acquired defect

Predisposing factors
•Being male
•Having muscle weakness from birth along with a hernia sac
•Having muscle weakness from aging
•Having one or more inguinal hernia
Precipitating factors
•Being overweight or having a recent,large weight loss
•Having weak abdominal muscles from poor diet, lack of exercise or both
•Straining during urination or bowel movements
•Chronic cough,such as from smoking
Incresed pressure in the compartment of the abdomen in develops
Intra-abdominal wall of inguinal canal into the scrotum becomes weakend
Causing the inguinal ring not to close
Evolves into a hole or defect
Fat or part of the small intestine slides through the inguinal canal
Swollen or enlarged scrotum
Feeling of weakness or pressure in the groin
Pain or discomfort


  • Genes involved in the pathogenesis of inguinal hernia include microdeletion disorders such as 22q11.2 microdeletion.[3]

Microscopic Pathology

  • On microscopic histopathological analysis, inflammatory infiltration, vascular damage and regressive nerve lesions, fibrohyaline degeneration and fatty dystrophy of the muscle fibers are characteristic findings of inguinal hernia. [4]


  1. Berliner SD (1983). "Adult inguinal hernia: pathophysiology and repair". Surg Annu. 15: 307–29. PMID 6353636.
  2. Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  3. Barnett C, Langer JC, Hinek A, Bradley TJ, Chitayat D (2009). "Looking past the lump: genetic aspects of inguinal hernia in children". J. Pediatr. Surg. 44 (7): 1423–31. doi:10.1016/j.jpedsurg.2008.12.022. PMID 19573673.
  4. Amato G, Agrusa A, Romano G, Salamone G, Cocorullo G, Mularo SA, Marasa S, Gulotta G (2013). "Histological findings in direct inguinal hernia : investigating the histological changes of the herniated groin looking forward to ascertain the pathogenesis of hernia disease". Hernia. 17 (6): 757–63. doi:10.1007/s10029-012-1032-0. PMID 23288217.

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