WBR0807

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 52-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?]]
Answer A	AnswerA::Inguinal ligament
Answer A Explanation	AnswerAExp::The inguinal ligament occupies the inferior aspect of the Hasselbach's triangle.
Answer B	AnswerB::Rectus abdominis muscle
Answer B Explanation	AnswerBExp::The rectus abdominis muscle occupies the medial aspect of the Hasselbach's triangle.
Answer C	AnswerC::Inferior epigastric artery
Answer C Explanation	AnswerCExp::The inferior epigastric vessels occupy the lateral aspect of the Hasselbach's triangle.
Answer D	AnswerD::Inferior epigastric vein
Answer D Explanation	AnswerDExp::The inferior epigastric vessels occupy the lateral aspect of the Hasselbach's triangle.
Answer E	AnswerE::Femoral vein
Answer E Explanation	AnswerEExp::The femoral vein occupies the lateral aspect of the femoral canal, a unique anatomic landmark that contains the femoral ring where femoral hernias are usually present.
Right Answer	RightAnswer::B
Explanation	[[Explanation::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. Educational Objective: The rectus abdominis muscle occupies the medial aspect of the Hasselbach's triangle, the most common anatomical location of direct hernias. References: Morton D, Foreman KB, Albertine K. Gross Anatomy: The Big Picture. McGraw Hill Professional; 2011.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Direct inguinal hernia, WBRKeyword::Hasselbach triangle, WBRKeyword::Indirect hernia, WBRKeyword::Hernia, WBRKeyword::Femoral, WBRKeyword::Rectus abdominis, WBRKeyword::Femoral vein
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::