An indirect inguinal hernia is considered mainly to be a congenital lesion.  It is denoted "indirect" because the bowel and peritoneum do not herniate directly through a weakness in the abdominal wall.  Rather, the bowel and peritoneum move through a patent processus vaginalis and into the scrotum.  This also lends to the analogy that "in"-direct hernias extend "in" through the internal ring.  As such, they technically protrude lateral to the inferior epigastric vessels. Indirect inguinal hernia has been associated with varicocele.

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