Hernia with highest rate of strangulation

Most strangulated hernias are indirect inguinal hernias, but femoral hernias have the highest rate of strangulation. The probability of strangulation is greatest in the first 3 months.


An indirect hernial sac is a dilated persistent processus vaginalis. It passes though the deep inguinal ring and follows the cord to the scrotum. At the deep ring, the sac occupies the anterolateral side of the cord. Properitoneal fat often is associated with the indirect sac and is known as a lipoma of the cord, although the fat is not a tumor. Retroperitoneal organs such as the sigmoid colon, cecum, and ureters may slide into an
indirect sac. They thereby become a part of the wall of the sac. Sliding hernias are often large and partially irreducible.


A hernia is a protrusion of a viscus through an opening in the wall of the cavity in which it is contained. The important features of a hernia are the hernial orifice and the hernial sac.
The hernial orifice is the defect in the innermost aponeurotic layer of the abdomen, and the hernial sac is the outpouch of peritoneum. The neck of a hernial sac corresponds to the orifice. The hernia is external if the sac protrudes completely through the abdominal wall and internal if the sac is within the visceral cavity. A hernia is reducible when the protruded viscus can be returned to the abdomen and irreducible when it cannot.
A strangulated hernia is one in which the vascularity of the protruded viscus is compromised. Strangulation occurs in hernias that have small orifices and large sacs. An incarcerated hernia is an irreducible hernia but not necessarily strangulated.
A Richter's hernia is a hernia in which the contents of the sac consist of only one side of the wall of the intestine (always antimesenteric).
Sites of Herniation The common sites of herniation are the groin, umbilicus, linea alba, semilunar line of Spieghel, diaphragm, and surgical incisions. Other similar but very rare sites of herniation are the perineum, superior lumbar triangle of Grynfelt, inferior lumbar triangle of Petit, and the obturator and sciatic foramina of the pelvis