A 64-year-old man comes to the office for the evaluation of a mass on the right side of his groin. The patient first noted the mass after helping his daughter move to a new home. He reports sharp
discomfort in the right groin worsens with walking and heavy lifting. Resting
supine decreases the severity of the pain. Past medical history is significant for
type 2 diabetes mellitus.
Current medications include
atorvastatin and
metformin. BMI is 37 kg/m2. Vitals are within normal limits. Physical examination shows a
bulge in the right groin above the
inguinal ligament which increases in size when the patient coughs. There is no overlying erythema or warmth. The patient is referred to a surgeon and scheduled for a laparoscopic repair.
Which of the following landmarks will help the surgeon to differentiate a direct versus an
indirect inguinal hernia?
