Your cart is currently empty!
M01.06.005 Hesselbach’s Triangle
The inguinal triangle (Hesselbach’s triangle) is a weak area in the anterior abdominal wall, through which direct inguinal hernias commonly occur. It is also called the medial inguinal fossa.
Borders of the Inguinal Triangle
| Border | Structure |
|---|---|
| Medial | Lateral border of the rectus abdominis muscle |
| Lateral | Inferior epigastric vessels |
| Inferior | Inguinal ligament |
Contents of the Inguinal Triangle
- No major anatomical structures are contained within the triangle.
- It marks an area of potential weakness, predisposing it to herniation.
Clinical Relevance: Direct Inguinal Hernia
- Definition: A direct inguinal hernia occurs when abdominal contents herniate through the inguinal triangle.
- Pathophysiology:
- The bowel pushes through a weakened posterior wall of the inguinal canal.
- Hernia is medial to the inferior epigastric vessels.
- It may exit through the superficial inguinal ring, forming a scrotal or labial mass.
- Risk factors:
- Aging
- Chronic cough (increased intra-abdominal pressure)
- Heavy lifting
Comparison: Indirect vs. Direct Inguinal Hernia
| Feature | Indirect Inguinal Hernia | Direct Inguinal Hernia |
|---|---|---|
| Definition | Protrusion of abdominal contents through the deep inguinal ring into the inguinal canal. | Protrusion of abdominal contents through the weakened posterior wall of the inguinal canal (inguinal triangle). |
| Cause | Congenital failure of the processus vaginalis to close. | Acquired weakness of the abdominal wall muscles. |
| Age Group | More common in infants and young adults. | More common in older adults due to muscle weakness. |
| Location | Lateral to the inferior epigastric vessels. | Medial to the inferior epigastric vessels. |
| Pathway | Hernia enters the deep inguinal ring, passes through the inguinal canal, and may exit via the superficial ring. | Hernia directly pushes through the inguinal triangle and may exit via the superficial ring. |
| Neck Position | Narrower neck, making it more prone to strangulation. | Wider neck, making strangulation less likely. |
| Scrotal Involvement | May descend into the scrotum (in males) or labia majora (in females). | Rarely extends into the scrotum or labia majora. |
| Palpation Findings | Hernia bulge felt at the deep inguinal ring (above the midpoint of the inguinal ligament). | Hernia bulge felt in the inguinal triangle (above the pubic tubercle). |
| Exacerbating Factors | Increased intra-abdominal pressure (e.g., lifting, straining, coughing). | Weakening of abdominal wall muscles (e.g., aging, chronic cough, heavy lifting). |
| Risk of Complications | Higher risk of strangulation and bowel obstruction. | Lower risk of strangulation due to wider neck. |
| Treatment | Often requires surgical repair (herniorrhaphy or hernioplasty). | May require surgical repair if symptomatic. |
Key Points to Remember
- The inguinal canal serves as a passage between the abdominal cavity and the external genitalia.
- The inguinal triangle is a region of abdominal wall weakness, where direct inguinal hernias occur.
- Indirect inguinal hernias occur lateral to the inferior epigastric vessels, while direct hernias occur medial to them.
- The deep inguinal ring is the entrance, and the superficial inguinal ring is the exit of the inguinal canal.
References
- Standring, S. (2020). Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Elsevier.
- Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2018). Clinically Oriented Anatomy. Wolters Kluwer.
- TeachMeAnatomy. (2025). The Inguinal Canal & Inguinal Triangle. Retrieved from TeachMeAnatomy