This patient had an incidental indirect hernia found at CT. Note the majority of small bowel has descended into the hernia dragging the mesentery with it.

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Indirect hernias are five times more common than direct hernias, and are seven times more frequent in males, due to persistence of the processus vaginalis during testicular descent. An indirect hernia enters the inguinal canal at the deep ring, passes inferomedially to emerge via the superficial ring and, if large enough, extend into the scrotum.
Contents may include small bowel loops, mobile colon segments (sigmoid, caecum, appendix), mesenteric fat, or urinary bladder.

Many are long standing and asymptomatic, although the sheer size can become burdensome. Complications include:
* incarceration
* strangulation with bowel ischaemia and perforation
* intestinal obstruction.

Credit: Dr Frank Gaillard