Hernias are the second most common cause of small bowel obstruction (10%) but are far behind adhesional small bowel obstructions (75%), which is the major cause in developing countries. Direct inguinal hernias occur through Hesselbach's triangle, and a good differentiator from indirect inguinal hernias is that they occur anteromedial (compared to anterolateral to indirect inguinal hernias) to the epigastric vessels.