It has generally been historically stated that indirect inguinal herni
as develop only in patients who have a patent processus vaginalis that
enlarges to become a hernia sac. Occasionally, this theory has been c
hallenged but without any objective evidence. Herniography was perform
ed by placing 50 mt of nonionic contrast material into the peritoneal
cavity. The patient was then placed in a prone position with the head
of the table elevated. Films of the inguinal fossae were obtained with
the patient straining. The herniogram revealed a right indirect ingui
nal hernia. There was no left inguinal hernia, nor was there a patent
processus vaginalis on the left side. Two years later, the patient dev
eloped left inguinal discomfort and swelling and was found to have a m
oderate-sized left inguinal hernia. At the time of operation, an indir
ect:sac of moderate size was present. A mesh plug repair was performed
. This case report is the first published objective evidence that, con
trary to common thought, a patent processus vaginalis is not a necessa
ry prerequisite to the development of an indirect inguinal hernia.