NBME Gross Anatomy High Yield Practice Test

The deep inguinal ring is the lateral entrance to the inguinal canal, formed in the transversalis fascia just lateral to the inferior epigastric vessels. An indirect inguinal hernia enters this deep ring and then passes through the inguinal canal, often reaching the scrotum, because it follows the pathway of the testes during development. This type typically arises from a persistent processus vaginalis, making it more common in males and often congenital.

In contrast, a direct inguinal hernia pushes through the posterior wall of the inguinal canal (Hesselbach’s triangle) and lies medial to the inferior epigastric vessels, not involving the deep ring. A femoral hernia goes through the femoral canal below the inguinal ligament, and an umbilical hernia protrudes at the umbilicus through the umbilical ring.

So, the hernia that enters the deep inguinal ring is the indirect inguinal hernia.