The hernia webinar refreshed my knowledge. I actually watched it lots of times.
For female patient, there is no spermatic cord for me to identify inguinal canal, I can’t see round ligament. This hernia is in inguinal triangle. It’s non reducible and no change with strain or Valsava. For large size patient, inguinal triangle is really a large area. Is every hernia in inguinal triangle will be a direct inguinal hernia? Or the hernia in inguinal triangle may not entering the inguinal canal, it’s possible just a lower abdominal wall hernia?
I am suspicious that this hernia is in fact a femoral hernia as in the short axis image it is adjacent to the femoral vein and in the long axis it looks like it comes out from under the inguinal ligament and inguinal canal.
In a female patient this would be a common hernia.
I am going for femoral in this case given there images you have provided.
Remember all inguinal hernias have to pass anterior to the inguinal ligament and all femoral hernias have to pass deep to (posterior) to the inguinal ligament.