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Hernias in the Inguinal Region Inguinal hernias: the inguinal ligament stretches from the anterior superior spine of the ilium to the pubic tubercle. The flattened tube of the inguinal canal lies just above and parallel to it, between the superficial and deep layers of abdominal muscles. The lateral end of the canal opens posteriorly into the abdominal cavity through the abdominal inguinal ring (internal ring). The internal ring is not palpable, but it is just above the midpoint of the inguinal ligament. The medial end of the canal opens anteriorly into the subcutaneous tissue through the subcutaneous inguinal ring (external ring). In the male, this is where the spermatic cord emerges from the abdominal muscles. A hernia is indirect when it enters the canal from the abdominal cavity through the abdominal inguinal ring; a hernia entering medial to this ring is direct. In small hernias, the relation of the bulge to the Source: The Abdomen, Perineum, Anus, and Rectosigmoid, DeGowin’s Diagnostic Examination, 10e midpoint of the inguinal ligament is diagnostic of direct or indirect. If the hernia is large, palpation of the inguinal canal through the scrotum may determine Citation: LeBlond RF, Brown DD, hernia SunejaisM,represented Szot JF. DeGowin’s Diagnostic Examination, 10e; 2015 at: http://mhmedical.com/ its site of entrance into the canal. The direct as an anterior bulging of the posterior wall ofAvailable the inguinal canal. Femoral hernia: the Accessed: May 10, 2017 femoral artery and vein emerge from the abdomen beneath the midpoint of the inguinal ligament, where the artery is palpable. The impalpable femoral vein Copyright © 2017 McGraw-Hill Education. All rights is immediately medial to it. The femoral canal lies medial to thereserved vein, so the canal is approximately 2 cm medial to the pulsating artery. A bulge in the region of the femoral canal is produced by a femoral hernia, especially on coughing or straining. The diagram shows a femoral hernia protruding upward in