Diagnostic ultrasound ( PDFDrive )

482 PART II Abdominal and Pelvic Sonography
FIG. 13.18 Indirect Inguinal Hernia. Long-axis extended–ield-of-view
(FOV) image shows extremely large, indirect inguinal hernia (H) extending
down the entire length of the inguinal canal into the scrotum. T, Testis.
See also Video 13.9.
FIG. 13.20 Direct Inguinal Hernia. Long-axis view of large, direct
inguinal hernia shows the thinned and stretched conjoined tendon and
underlying transversalis fascia and peritoneum (arrows) forming the
hernia sac. Note that the neck of direct inguinal hernias arises inferior
and medial to the inferior epigastric artery (circle).
Lateral edge of rectus abdominis muscle
Hesselbach triangle
Inferior epigastric vessels
Inguinal ligament
FIG. 13.19 Direct Inguinal Hernia. Long-axis view shows fatcontaining
direct inguinal hernia passing through an acute tear (*) in the
conjoined tendon (arrows) and extending down the inguinal canal
(arrowheads).
Femoral hernias arise within the femoral canal inferior to the
inguinal canal and ilioinguinal crease. he femoral canal lies
just medial to the common femoral vein (CFV) and just superior
to the saphenofemoral junction (Fig. 13.26, Video 13.10). he
most common location for femoral hernias is medial to the CFV,
but a few lie anterior to the common femoral vessels (Figs. 13.27
and 13.28). Most femoral hernias that lie anterior to the CFV
arise medially and then extend anteriorly. It is rare for a femoral
hernia to actually arise anteriorly (Teale hernia) (Fig. 13.29).
Although femoral hernias reportedly can lie posterior or lateral
to the CFV, we have never seen one in either of these locations.
A femoral hernia tends to have a narrow neck in comparison
FIG. 13.21 Direct Inguinal Hernia. Diagram of the deep aspect of
the anterior abdominal wall depicting a left direct inguinal hernia. The
hernia sac protrudes through the Hesselbach triangle, which is bounded
by the inferior epigastric vessels, lateral edge of the rectus abdominis
muscle, and inguinal ligament. (With permission from Granja M, Rivero
O, Aguirre D. Abdominal wall hernias. In: Sahani DV, Samir AE, editors.
Abdominal imaging. 2nd ed. Philadelphia: Elsevier; 2017:1014-1025. 43 )
to the width of its fundus, a shape that predisposes the femoral
hernia to strangulation. Because of the narrowness of the femoral
ring (the opening that forms the neck of a femoral hernia), it is
more likely than an inguinal hernia to become incarcerated and
strangulated 24,31 (Fig. 13.30). Femoral hernia contents vary, and
most contain only fat. Femoral hernias that contain bowel are
almost always nonreducible and frequently are strangulated.