Sutures and Wound Repair/ General Surgery (ABSA) Practice Test

Which statement regarding hernias is NOT true?

1. Incarcerated hernia causes acute intestinal obstruction

2. Strangulated hernia causes acute intestinal obstruction

3. Direct hernia leaves the abdomen through inguinal ring

4. Femoral hernia appears below Poupart's ligament

The correct answer is: Direct hernia leaves the abdomen through inguinal ring

The statement that a direct hernia leaves the abdomen through the inguinal ring is incorrect. In fact, a direct hernia protrudes through a weakness in the abdominal wall, specifically in the Hesselbach triangle, which is located medial to the deep inguinal ring. It typically occurs in older adults and is associated with a weakness of the lower abdominal wall rather than passing through the inguinal ring itself. In contrast, the other statements are true. An incarcerated hernia does indeed cause acute intestinal obstruction because the contents of the hernia cannot be reduced back into the abdominal cavity, potentially leading to complications. A strangulated hernia causes acute intestinal obstruction as well but with the added risk of losing blood supply to the incarcerated tissue, which can lead to necrosis. Similarly, a femoral hernia does appear below Poupart's ligament, which is the ligament that runs from the anterior superior iliac spine to the pubic tubercle, and this type of hernia typically occurs in the femoral canal below the inguinal ligament.