Hesselbach Triangle

What Is It, Location, and More

Author: Alyssa Haag

Editors: Ian Mannarino, MD, MBA, Ahaana Singh

Illustrator: Jillian Dunbar


What is the Hesselbach triangle?

The Hesselbach triangle, also called the inguinal triangle, is a region of the lower, anterior abdominal wall, or groin, that was first described by Frank Hesselbach, a German surgeon and anatomist, in 1806. It describes a potential area of weakness in the abdominal wall, through which a hernia can protrude. A hernia is defined as a protrusion of an organ or fascia, a thin sheath of tissue that encloses a muscle or organ, through the wall that usually contains it. A hernia of the anterior abdominal wall is typically a protrusion of the intestines.

Where is the Hesselbach triangle located?

The Hesselbach triangle is located in the anterior abdominal wall bilaterally (on both the right and left sides) and has three major boundaries: the medial boundary consisting of the rectus abdominis muscle; the lateral boundary consisting of the inferior epigastric vessels, which supply the anterior abdominal wall with blood; and the inferior boundary consisting of the inguinal ligament, a narrow band of tissue in the pelvic region of the body. 

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How big is the Hesselbach triangle?

The size of the Hesselbach triangle varies from person to person as each individual’s anatomy and body is different.

What is the difference between a direct and an indirect inguinal hernia?

A direct inguinal hernia protrudes through the Hesselbach triangle, while an indirect inguinal hernia does not. However, both types of hernia will likely involve intestines or bowel. 

A direct inguinal hernia typically occurs in older individuals from weakness in the abdominal wall due to age. A direct inguinal hernia occurs when the intestines protrude through the Hesselbach triangle into the inguinal canal, a short passageway in the anterior abdomen which allows structures to transverse the abdominal wall to the external genitalia. Once in the inguinal canal, the hernia can then pass through and exit the inguinal canal through the superficial inguinal ring. This protrusion creates the characteristic lump in the groin that can be seen with a direct inguinal hernia. 

Conversely, an indirect inguinal hernia occurs most frequently in males during both infancy and in older age, due to an incomplete closure of the deep inguinal ring, or entrance of the inguinal canal. In males, the deep inguinal ring, which allows the testicles to drop during puberty, is generally closed once the testicles descend into the scrotum. However, if it does not close completely, an indirect inguinal hernia can develop. 

Unlike a direct inguinal hernia, which only penetrates the superficial inguinal ring of the inguinal canal after creating its own entrance into the inguinal canal, an indirect inguinal hernia enters the inguinal canal through both the deep inguinal ring and the superficial inguinal ring before protruding, most commonly, into the scrotum. An indirect inguinal hernia does not protrude through a weakness in the wall of the Hesselbach triangle.

What are the most important facts to know about the Hesselbach triangle?

The Hesselbach triangle, also called the inguinal triangle, is a region of the lower anterior abdominal wall. If weakened, the Hesselbach triangle can allow for the protrusion of the intestines through the wall, known as a direct inguinal hernia. This region is bound by the inguinal ligament, inferior epigastric vessel, and rectus abdominis muscle. While a direct inguinal hernia protrudes through a weakness in the muscle of Hesselbach’s triangle, an indirect inguinal hernia does not. Additionally, an indirect inguinal hernia will protrude through both the superficial and deep inguinal ring, whereas the direct inguinal hernia will only protrude through the superficial inguinal ring.

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Related links

Abdominal hernias
High Yield: Congenital gastrointestinal disorders

Resources for research and reference

Jones, O. (2018). The Inguinal (Hesselbach's) Triangle. In TeachMeAnatomy. Retrieved November 17, 2020, from https://teachmeanatomy.info/abdomen/areas/inguinal-triangle/

Roland, J. & Falck, S. (2017). What You Should Know About Direct versus Indirect Hernias. In Healthline. Retrieved December 3, 2020, from https://www.healthline.com/health/direct-vs-indirect-hernia