Direct inguinal hernias are best described as:

• A. Hernia sac goes through Hesselbach's triangle and comes out medial to inferior epigastric vessels
• B. Enters through the deep inguinal ring lateral to inferior epigastric vessels
• C. Descends behind the spermatic cord
• D. Protrudes through the femoral canal

Answer: (A)

Direct inguinal hernias occur when weakness in the floor of the inguinal canal allows the abdominal contents to bulge directly through the abdominal wall within Hesselbach's triangle, and crucially, this protrusion lies medial to the inferior epigastric vessels. This medial position relative to those vessels distinguishes them from indirect hernias, which pass through the deep inguinal ring and are located lateral to the vessels. So the description that the sac goes through Hesselbach's triangle and lies medially to the inferior epigastric vessels correctly identifies a direct inguinal hernia.