Which of the following statements regarding direct inguinal hernias is true? (AIIMS Nov 2010)
|A||They are the most common inguinal hernias in woman|
|B||They protrude medially to the inferior epigastric vessels|
|C||They should be opened and ligated at the internal ring|
|D||They commonly protrude into the scrotal sac in men|
a. The inguinal canal is about 4 cm in length and is located 2 to 4 cm cephalad to the inguinal ligament.
b. The canal extends between the internal (deep) inguinal and external (superficial) inguinal rings. The inguinal canal contains the spermatic cord and the round ligament of the uterus.
c. The spermatic cord is composed of cremasteric muscle fibers, the testicular artery and accompanying veins, the genital branch of the genitofemoral nerve, the vas deferens, the cremasteric vessels, the lymphatics, and the processus vaginalis.
d. The cremaster muscle arises from the lowermost fibers of the internal oblique muscle and encompasses the spermatic cord in the inguinal canal.
e. The cremasteric vessels are branches of the inferior epigastric vessels and pass through the posterior wall of the inguinal canal through their own foramen.
f. These vessels supply the cremaster muscle and can be divided to expose the floor of the inguinal canal during hernia repair without damaging the testis.
g. The inguinal canal is bounded superficially by the external oblique aponeurosis.
h. The internal oblique and transversus abdominis musculoaponeurosis form the cephalad wall of the inguinal canal.
i. The inferior wall of the inguinal canal is formed by the inguinal ligament and lacunar ligament.
k. Hesselbach's trianglerefers to the margins of the floor of the inguinal canal.
l. The inferior epigastric vessels serve as its superolateral border, the rectus sheath as medial border, and the inguinal ligament as the inferior border.
m. Direct hernias occur within Hesselbach's triangle, whereas indirect inguinal hernias arise lateral to the triangle.