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During abdominal dissection of a male cadaver, aged 60 years at death, a peritoneal fold formed by mesentery of the terminal ileum and attached to the anterior wall was encountered in the abdominal cavity. Distal part of the terminal ileum, cecum, and colon ascendens were herniated from the medial inguinal fossa. The unusually located peritoneal fold was interpreted as a predisposing factor for the accompanying direct inguinal hernia. The subject is discussed in terms of embryonic development of the midgut.

During the abdominal dissection of a 67-year-old male cadaver, an unusual peritoneal fold was encountered on the inner surface of the anterior abdominal wall. The peritoneal fold had two parts: the anterior part was located at the midsagittal plane including dispersed urachus remnants, the other part was located at the coronal plane with a triangular shape at the posterior edge of the sagittal part. Remnants of the umbilical arteries were ascending in the lateral margins of the coronal part. Accordingly, two peritoneal sacs were formed on both sides of this abnormal fold. Part of the small bowel herniated into the left peritoneal sac situated on the left side of the bladder. Although the aperture of the hernia sac was at the lateral side of the remnant of the umbilical artery which is concordant with the normal position of the medial inguinal fossa, the bottom of the sac was found to be located at the supravesical region. Therefore, this case was interpreted as an internal supravesical hernia with an unusual course. Although these rarely seen internal supravesical hernias in the literature were reported to be observed either preoperatively or postoperatively, to our knowledge our case is the first to be revealed in a cadaver which in detail enabled us to examine the features of this unique peritoneal variation and accompanying anatomic structures that caused hernia formation.

Nineteen patients with direct diverticular inguinal hernia (DDIH) were examined with herniography and surgically explored. A lump medially in the groin and pain were the prominent clinical manifestations in 18 patients. Physical examination indicated the presence of a DDIH in 6 patients. In 16 patients herniography revealed hernial sacs protruding from the supravesical fossa in 5 and from the medial inguinal fossa in 11. At operation a circumscribed defect was found in the transverse fascia laterally and cranially to the pubic tubercle in all patients. In 16 patients peritoneal hernial sacs were demonstrated at surgery while in 3 only lipomas (fatty hernia) were contained within the defect. In our opinion DDIH is a specific variety of inguinal hernia with a fairly typical clinical presentation and radiographic appearance but probably often overlooked at surgery.

Inguinal hernias can be demonstrated by positive contrast herniography in children and adults. In this latter age-group direct inguinal hernias are frequent and can appear with different location and shape. In this series of 39 inguinal hernias in 25 adults five different types could be distinguished, according to location. Lateral direct inguinal hernias were found protruding in an anterior direction from the medial inguinal fossa. Inguinofemoral hernias protruded in a mainly inferior direction from the medial inguinal fossa. Medial direct inguinal hernias protruded from the lateral region of the supravesical fossa just medial to the medial inguinal fold. Diverticular direct inguinal hernias were located in the medial aspect of the supravesical fossa. Supravesical inguinal hernias were located in the mid-line. The distinction between these direct hernias and their relation to and distinction from other hernias in the inguinal region is discussed.