 So, coming to the pantalones hernia, as we have seen it is a type of inguinal hernia with both direct as well as indirect inguinal hernias are seen on the same side and concurrently. They are also called as dual hernias or dual inguinal hernias or rhomboc hernias or saddle beg hernias. This is the inferior epigastric vessel, these are the, this is the inguinal ligament and these hernias are seen on the both the side, this is indirect and this is the direct. And both this direct and indirect inguinal hernias are separated by the posterior wall of the inguinal canal which is brought down by the direct inguinal hernia. And this is the structure, posterior wall of the inguinal canal which is seen separating two hernia sex is the criteria on CT or MRI or cross sectional imaging to be shown in each case to make the final diagnosis of dual or pantalones hernia. Pantalone hernias are named because two hernia sex divided by the epigastric vessels are looking and producing the image like a pair of pants from the 17th century and that is why they are called as pantalones hernia. There is increased risk of developing recurrent hernias in these cases. According to some cases if we can see this first case here this is the indirect inguinal hernia and this is the direct inguinal hernia. So this was the indirect inguinal hernia which was coming from the internal inguinal ring and this is the direct inguinal hernia. So both hernias are seen on one side and on the opposite side only direct inguinal hernia is seen. So this was the direct inguinal hernia. Now if you can see once more these are the inferior epigastric vessels which was delineating the indirect inguinal hernia and then this was indirect and then there was the wall and this is the direct inguinal hernia, indirect vessel, direct, indirect, direct and this is the posterior wall of the inguinal canal. So that is what we have to show and you can see also some vessel which is the inferior epigastric vessels. So both indirect, direct, posterior wall separating and inferior epigastric vessels. So this all criteria are met. So this is the right sided pantaloons hernia. This is very small and subtle case where both the hernias are seen. So this was the indirect inguinal hernia and this was the direct inguinal hernia above. So this is a small hernia which was indirect and then this was the direct inguinal hernia. This is the third case in which bilateral pantaloons hernias are seen. So if you can see there were small inguinal hernias which were indirect on both the sides and there was small direct hernia on right and large direct hernia on the left side. So again we will see this is indirect, here it is indirect because the vessels are running medial that is over and now this is a small right direct and larger left direct inguinal hernia. So bilateral pantaloons hernias. Here also we can see bilateral pantaloons hernias. So just as we go above these are the indirect, indirect here they get over and then both direct inguinal hernias again indirect getting over and then direct arising now. Again here we can see left sided pantaloons hernia. So this was direct again we will go above this was indirect this was the vessel separating and then this was direct. Here on the right side this was the inguinal indirect and then this was direct. Again this was the vessel coming so this was indirect and then this was direct. So pantaloons hernia on this was a case with anal carcinoma if you can just go down. So this was a carcinoma with multiple lymph nodes bilaterally. But here we can see this was the indirect inguinal hernia this was the and this was the direct inguinal hernia again indirect inguinal vessels were lying medially and then this was direct inguinal hernia. Now these are the static imaging in this particular case and we can see on the right side this was the hernia which was coming above from the internal inguinal ring region and this linear structure was there this is that linear structure. So small amount of fluid is seen in the indirect inguinal hernia and this was the posterior wall of the inguinal canal which was separating the direct inguinal hernia which is seen better inferiorly. So here we can see direct and indirect inguinal hernia which are separated by posterior wall of the inguinal canal. So this becomes right sided pantaloons hernia. This is another case where a direct inguinal hernia on the right side shows bladder herniating within it. You can see the bladder herniating in the right sided direct inguinal hernia but what is more important is this so this is the inguinal canal in which the hernia is entering and the vessels are passing middle to it. So this becomes indirect inguinal hernia. So that hernia is getting over and for this hernia the vessels are passing lateral to it. So this becomes a direct inguinal hernia which is coming out from here. This is the direct inguinal hernia and as we go down we see small amount of fluid in this hernia sac inferiorly. So this becomes right sided direct inguinal hernia with bladder within it and left sided pantaloons hernia. This is another case where we can see bilateral indirect they are over and then these are bilateral direct. So bilateral pantaloons hernias. This is case of MRI where on the left side we can see this is the indirect inguinal hernia over and this is the direct inguinal. So again indirect over direct, indirect over and this is the direct. And this was a case of endometrial carcinoma which we can see here. CT is the best modality to diagnose pantaloons hernia. MRI and sonography also have a role. The pre-operative diagnosis with CT scan non-invasively allows proper surgery and secondly it prevents post-operative complications. Recurrence is most common because if we do not report usually they may either operate the internal inguinal hernia or direct inguinal hernia and may leave another inguinal hernia untreated. So it is important to describe the exact morphology, extent and dimensions of both hernias with clear description of their contents and any complications such as obstruction, strangulation, incarceration, infection or ischemia etc. According to the treatment usually Hockeit's manure is used which basically causes ligation of the inferior epigastric vessels and in same setting the direct and indirect components of the hernias are converted into single sac and then that sac is removed and repairing of the abdominal wall openings is done. So for repairing either hernioplasty with mesh or herniography with surgery and incision or laparoscopic approaches are described and if it is left untreated strangulation and obstructions are frequently reported.