larger opening and therefore a much weaker wall through which the intestines may protrude. Inguinal hernias, in turn, belong to groin hernias, which also includes femoral hernias. A femoral hernia is not via the inguinal canal, but via the femoral canal, which normally allows passage of the common femoral artery and vein from the pelvis to the leg. In Amyand's hernia, the content of the hernial sac is the vermiform appendix. In Littre's hernia, the content of the hernial sac contains a Meckel's diverticulum. Clinical classification of hernia is also important according to which hernia is classified into Reducible hernia: is one which can be pushed back into the abdomen by putting manual pressure to it. Irreducible/Incarcerated hernia: is one which cannot be pushed back into the abdomen by applying manual pressure. Irreducible hernias are further classified into Obstructed hernia: is one in which the lumen of the herniated part of intestine is obstructed. Strangulated hernia: is one in which the blood supply of the hernia contents is cut off, thus, leading to ischemia. The lumen of the intestine may be patent or not. Direct inguinal hernia The direct inguinal hernia enters through a weak point in the fascia of the abdominal wall, and its sac is noted to be medial to the inferior epigastric vessels. Direct inguinal hernias may occur in males or females, but males are ten times more likely to get a direct inguinal hernia. A direct inguinal hernia protrudes through a weakened area in the transversalis fascia near the medial inguinal fossa within an anatomic region known as the inguinal or Hesselbach's triangle, an area defined by the edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery. These hernias are capable of exiting via the superficial inguinal ring and are unable to extend into the scrotum. When a patient develops a simultaneous direct and indirect hernia on the same side, it is called a pantaloon hernia or saddlebag hernia because it resembles a pair of pants with the epigastric vessels in the crotch, and the defects can be repaired separately or together. Another term for pantaloon hernia is Romberg's hernia. Since the abdominal walls weaken with age, direct hernias tend to occur in the middle-aged and elderly. This is in contrast to indirect hernias which can occur at any age including the young, since their etiology includes a congenital component where