PAEA Surgery End Of Rotation (EOR) Practice Exam

In a direct inguinal hernia, where do the peritoneal contents protrude?

1. Into the scrotum

2. Through the abdominal wall within Hesselbach's triangle

3. Beneath the inguinal ligament

4. At the umbilicus

The correct answer is: Through the abdominal wall within Hesselbach's triangle

In a direct inguinal hernia, the peritoneal contents protrude through the abdominal wall within Hesselbach's triangle. Hesselbach's triangle is defined by the inguinal ligament, the lateral border of the rectus abdominis muscle, and the inferior epigastric vessels. This area is a natural weak point in the abdominal wall where the muscles are not as reinforced, making it more susceptible to hernia formation. As a direct hernia occurs, the hernia sac pushes through the transversalis fascia and into the inguinal canal, but it does so medial to the inferior epigastric vessels, which distinguishes it from an indirect inguinal hernia that occurs through the inguinal canal and is lateral to these vessels. Understanding this anatomical relationship is crucial as it affects both the presentation and the surgical approach to correcting the hernia. The other options indicate different situations or areas related to hernias. For example, peritoneal contents protruding into the scrotum is typical of an indirect inguinal hernia, while beneath the inguinal ligament is not a typical site of hernia protrusion for either direct or indirect hernias. The umbilicus is associated with umbil