1. Reducible hernia
Normally an uncomplicated hernia is reducible. That means its
contents can be returned into the abdominal cavity but the sac remains in its
2. Irreducible hernia
In this hernia the contents cannot be returned to the abdomen.
3. Obstructed or Incarcerated hernia
(Irreducibility + Intestinal obstruction)
An obstructed hernia means the hernia is associated with intestinal
obstruction due to occlusion of the lumen of the bowel.
4. Strangulated hernia
(Irreducibility + Obstruction + Arrest of blood supply to the contents)
A hernia is said to be strangulated when the contents are so constricted
as to be interfered with their blood supply.
5. Inflamed hernia
This is a very rare condition and mimics in many respects a
strangulated hernia. This hernia may occur when its content such as an
appendix, a salpinx or a Meckel’s diverticulum becomes inflamed.
DIRECT INGUINAL HERNIA
Between 10 and 15 % of inguinal herniae are direct. Over half of the
herniae are bilateral.
A direct inguinal hernia is always acquired. The sac passes through a
weakness of defect of the transversalis fascia in the posterior wall of the
inguinal canal. In some cases, the defect is small and closely related to the
insertion of the conjoint tendon; occasionally congenitally deficient, while in
others there is a generalized bulge through Hesselbach’s triangle. Often the
patient is a man with poor abdominal musculature, as shown by the presence
of Malgaigne’s bulgings. Women practically never develop a direct inguinal
hernia. Predisposing factors are a chronic cough, straining and heavy work.
Damage to the ilioinguinal nerve (Ex: By previous appendicectomy) is
another known cause.
Direct herniae rarely attain a large size and descend into the scrotum.
In contradistinction to an oblique inguinal hernia, a direct inguinal hernia lies
behind the spermatic cord. The sac is often smaller than the hernial mass
would indicate, the protruding mass mainly consisting of extra – peritoneal
fat. A finger inserted into the superficial inguinal ring passes directly
backwards into the abdomen. As the neck of the sac is wide, direct inguinal
hernias rarely strangulate.
On coughing, the impulse is felt on the pulp of the finger whereas in
an oblique hernia the impulse is felt on the finger tip, viz. oblique direct.
The inferior epigastric artery lies lateral to the aperture, but because of
its small size and the nature of its coverings, it cannot be felt, those who
pretend to feel it surrender themselves to a flattering delusion.
At operation the distinguishing features of a direct inguinal hernia are,
that the sac lies medially to the inferior epigastric artery, and the spermatic
cord is not attached to the wall of the sac. The sac is often smaller that the
hernial mass would indicate the protruding mass mainly consisting of
extraperitoneal fat. As the neck of the sac is wide, direct inguinal herniae