Hernia DOI 10.1007/s10029-013-1184-6
CASE REPORT
Giant gluteal lipoma presenting as a sciatic hernia A. Dulskas • E. Poskus • S. Jurevicius K. Strupas
•
Received: 23 February 2013 / Accepted: 31 October 2013 Ó Springer-Verlag France 2013
Abstract Background Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. Case presentation A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms—6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. Conclusion The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.
A. Dulskas (&) E. Poskus S. Jurevicius K. Strupas Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University Hospital, Santariskiu Clinics, 2 Santariskiu Street, 08661 Vilnius, Lithuania e-mail: [email protected]
Keywords Sciatic hernia Gluteal hernia Lipoma Retroperitoneal Pelvic floor
Introduction Hernias of the pelvic floor are extremely rare and often present diagnostic and therapeutic dilemmas. Three main types of pelvic floor hernias have been described including, in order of decreasing frequency, obturator, perineal and sciatic. Sciatic hernias are considered the rarest, with a very limited number of published reports worldwide. The sciatic hernia was first described by Papen in 1750 [1]. These hernias are of three types. Type 1 (suprapiriform) is the most common (60 %), followed by subpiriform, type 2 (30 %), while type 3 (subspinous—through the lesser sciatic foramen) is the least common [2, 3] (Fig. 1). We present a case of gluteal lipoma protruding into retroperitoneum with symptoms of compression.
Case report A 53-year-old male presented with an expanding, slightly reducible, painful right gluteal mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, intermittent, other symptoms—around 6 months. No spinal pathology was found on X-ray. There was no history of abdominal surgery of any type. On examination, patient looked well-nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Laboratory tests revealed no changes. CT
123
Hernia
1. 2. 3. 4. 5. 6.
Piriform muscle. Sacrospinous lig. Sacrotuberous lig. Suprapiriform aperture. Infrapiriform aperture. Lesser sciatic foramen.
Fig. 3 Intraoperative view of lipoma displacing right common iliac artery and right ureter anteriously
Fig. 1 Anatomic locations of sciatic hernias. 1 Piriform muscle, 2 Sacrospinous lig, 3 Sacrotuberous lig, 4 Suprapiriform aperture, 5 Infrapiriform aperture, 6 Lesser sciatic foramen
1. Opened endopelvic fascia (reflection). 2. Hernia. 3. Piriform muscle. Fig. 4 Transabdominal approach: schematic view. 1 Opened endopelvic fascia (reflection), 2 Hernia, 3 Piriform muscle
Fig. 2 Gluteal lipoma protruding into retroperitoneum
scan demonstrated a large, well-defined right gluteal fatty mass. The mass was 124 9 55 9 182 mm in size. It was located behind right gluteus maximus muscle, between superior gemellus and internal obturator muscles. Traveling through the greater sciatic foramen it displaced the rectum to the left, right common iliac artery and right ureter anteriously (Fig. 2). The tumor was homogeneously isointense with fat. Elective surgery was done through a lower middle laparotomy approach. To fully reduce the
123
tumor back into the pelvic cavity (via the greater sciatic foramen) and maintain its position there, an assistant was employed to exert external manual pressure on the right buttock throughout the procedure. The tumor was surgically removed (Fig. 3). Few sutures were placed on piriform muscle defect. The sciatic foramen was covered by a patch of endopelvic fascia (Figs. 4, 5). Subsequent pathological examination revealed the tumor as a lobulated mass of adipose tissue measuring 120 9 95 9 35 mm (Fig. 6). Histopathological examination revealed fatty tissue cells with fibric strings and vessels. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery.
Hernia
1. Sutures closing piriform muscle defect. 2. Sutures on endopelvic fascia.
Fig. 5 Transabdominal approach: scheme of covering the defect. 1 Sutures closing piriform muscle defect, 2 Sutures on endopelvic fascia
Discussion Lipomas are a benign variant of liposarcomas located in the peritoneal cavity, and especially in retroperitoneum. They are exceptionally rare, judging by reports published on this matter. Usually they are asymptomatic, because of slow growth. Symptoms appear late and have non-specific features [4]. Sciatic hernia is an extremely rare diagnosis. It occurs in both children and adults, with a female predomination in the adult cases [5–7]. This may be explained with larger pelvis and sciatic foramina in women [8]. There is still ongoing discussion about the etiology of this rare condition. Some authors believe that the neuromuscular diseases, hip pathology causing atrophy of piriform muscle are the main factors [1, 4]. Other theories have suggested increased intra-abdominal pressure, adhesions [5], congenital anomalies or fascial defects [8] as possible causes. The sciatic notch on the inferior margin of the pelvis is divided into the greater and lesser sciatic foramina by the sacrospinous and sacrotuberous ligaments. The greater sciatic foramen is subdivided by piriform muscle into suprapiriformis and infrapiriformis foramen. Sciatic hernias may emerge through either the supra- or infra-piriform spaces or through the lesser sciatic foramen. Patients often complaint of various extent and localization pain: from acute to chronic pelvic [7], back, perineal, buttock or radiating to thigh. Our patient was complaining of lower back, buttock pain; dull pressure in lower abdomen (pelvis) and perineum. Sciatic hernias may present as gluteal mass [5, 10–12], causing sciatica, or with complications of their content. Such contents can include small/large bowel— causing intermittent or progressive intestinal distention, with nausea and vomiting [3, 8, 10–14], the ureter or bladder— causing ureteric colic or urinary sepsis [6, 9, 13–17], ovaries
Fig. 6 Removed lipoma—gross specimen
and fallopian tubes causing pelvic pain [7, 18]. Other documented components of hernia sac are omentum, Meckel’s diverticulum [1], appendical carcinoma, angiomyxoma, lipoma [5, 11, 12, 19]. To our knowledge, there were only four previous descriptions of lipoma herniating through the sciatic foramen. Sciatic hernia can also lead to abscess formation in the gluteal region, particularly after perforation of strangulated bowel [13]. Diagnosis is rare on physical examination because of thickness of overlying tissues. Sometimes palpable mass, deforming gluteal region may be seen. In our patient it was a few centimeters palpable, painless lipoma-like mass in the right gluteus. It was slightly reducible. Sometimes intravenous pyelography, enterography/proctography, cystography, ultrasound, plain X-ray may be used. But today CT scan and MRI are preferred as preoperative diagnostic modalities. In our case, CT scan demonstrated a large, well-defined 124 9 55 9 182 mm right gluteal fatty mass behind right gluteus maximus muscle, between the superior gemellus muscle and internal obturator muscle traversing the greater sciatic foramen displacing rectum to the left, bladder, right common iliac artery and right ureter anteriously (Figs. 2, 3, 4). The tumor was homogenously isointense with fat. Sometimes sciatic hernia may be an accidental finding during other procedure [20]. Repair was historically through a midline transabdominal, transgluteal or combined approach followed by direct suture [1, 4, 7, 12, 13, 15]. Transabdominal approach is recommended in patients who present with bowel incarceration or strangulation [1] (Fig. 4). Free fascial flaps, non-absorbable sutures, prosthetic mesh (Gore-tex, polypropylene), plug, patch, plug and patch may be used for larger hernias in the absence of contamination [1, 3, 7, 12– 14]. The mesh is preferably positioned in the extraperitoneal space—for reducing the incidence of intra-abdominal adhesions which can cause nerve entrapment or bowel
123
Hernia Conflict of interest
I (we) certify that there is no conflict of interest.
References
1. 2. 3. 4. 5. 6. 7. 8. 9.
Gluteus maximus muscle (cut). Gluteus medius muscle. Piriform muscle. Suprapiriform aperture. Infrapiriform aperture. Lesser sciatic foramen. Sacrospinouslig. Sacrotuberouslig. Sciatic nerve.
Fig. 7 Transgluteal approach. 1 Gluteus maximus muscle (cut), 2 Gluteus medius muscle, 3 Piriform muscle, 4 Suprapiriform aperture, 5 Infrapiriform aperture, 6 Lesser sciatic foramen, 7 Sacrospinous lig, 8 Sacrotuberous lig, 9 Sciatic nerve
obstruction [1, 6, 14]. The mesh can be anchored to the periosteum of the inner side of the pubis, laterally to the arcuate line of the ilium, medially to the levator ani muscle, and posteriorly to the periosteum of the sacrum [1]. Anchoring of the prosthesis to the peritoneum brings the risk of injury to the underlying nerves and vessels [6]. Miklos et al. [7] reported their successful experience with the laparoscopic treatment of sciatic hernia in their female patients. Singh et al. [20] reported a successful robotassisted laparoscopic repair of sciatic hernia. Alternatively a transgluteal approach can be used [15]. It is accomplished through the gluteus maximus muscle (Fig. 7). The muscle can be split along a line that connects the major trochanter and the middle portion of the sacrum, corresponding to the course of the piriform muscle [2, 11]. This approach presents significant risks of iatrogenic neurovascular injury, especially if the hernia is large, or complicated by tissue fibrosis obscuring the anatomic planes. However, it can be very useful as part of a combined operation (abdominal and gluteal) to facilitate identification and reduction of the hernia, or to permit complete resection of a retroperitoneal tumor that protrudes from the retroperitoneum through the sciatic foramen [4]. Unfortunately, there are no long-term data comparing different repair types [1]. In our case, transabdominal approach was chosen. The tumor was surgically removed. The sciatic foramen was covered by a patch of endopelvic fascia.
123
1. Losanoff JE, Basson MD, Gruber SA, Weaver DW (2010) Sciatic hernia: a comprehensive review of the world literature (1900–2008). Am J Surg 199(1):52–59 2. Summers JE (1922) Sciatic hernia. Ann Surg 75(6):672–676 3. Rather SA, Dar TI, Malik AA, Parray FQ, Ahmad M, Asrar S (2011) Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report. Ulus Travma Acil Cerrahi Derg 17(3):277–279 4. Singh G, Bharadwaj RN, Purandare SN, Gore CR, Dubhashi SP, Vaidya S, Patil A, Kompally GR (2011) Giant retroperitoneal lipoma presenting as inguinal hernia. Indian J Surg 73(3): 187–189 5. Skipworth RJE, Smith GHM, Stewart KJ, Anderson DN (2006) The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia. World J Surg Oncol 4:33–41 6. Weintraub JL, Pappas GM, Romano WJ, Kirsch MJ, Spencer W (2000) Percutaneous reduction of ureterosciatic hernia. AJR Am J Roentgenol 177:181–182 7. Miklos J, O’reilly M, Saye WB (1998) Sciatic hernia as a cause of chronic pelvic pain in women. Obster Gynecol 91:998–1001 8. Ghahremani GG, Michael AS (1999) Sciatic hernia with incarcerated ileum: CT and radiographic diagnosis. Gastrointest Radiol 16:120–122 9. Tsai P, Lin J, Wu TT, Tsai C (2008) Ureterosciatic hernia causes obstructive uropathy. J Chin Med Assoc 71(9):491–493 10. Servant CTJ (1998) An unusual cause of sciatica: a case report. Spine 23:2134–2136 11. Guerado E, Aguiar F (2006) Rectum compression by a gluteal lipoma. Lancet 368:1893 12. Fernandez EML et al (2012) Intermuscular lipoma of the gluteus muscles compressing the sciatic nerve: an inverted sciatic hernia. J Neurosurg 117(4):795–799 13. Yu PC, Ko SF, Lee TY, Ng S, Huang CC, Wan YL (2002) Small bowel obstruction due to incarcerated sciatic hernia: ultrasound diagnosis. Br J Radiol 75:381–383 14. Chitranjan, Kandpal H, Madhusudhan KS (2010) Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. Br J Radiol 83(987):65–66 15. Chaudhuri A, Chye KK, Marsh SK (1999) Sciatic hernias: choice of optimal prosthetic repair material in preventing long-term morbidity. Hernia 4:229.Her–231.Her 16. Tokunaga M, Shirabe K, Yamashita N, Hiki N, Yamaguchi T (2008) Bowel obstruction due to sciatic hernia. Dig Surg 25:185–186 17. Witney-Smith C, Undre S, Salter V, AL-Akraa M (2007) An unusual case of a ureteric hernia into the sciatic foramen causing urinary sepsis: successfully treated laparoscopically. Ann R Coll Surg Engl 89:1–3 18. Bernard AC, Lee C, Hoskins J, Lee J, Patel S, Ginn G, Maley B (2010) Sciatic hernia: laparoscopic repair with plug and transabdominal extraperitoneal patch. Hernia 14:97–100 19. Kerry RL, Tygart RL, Glass WW (1964) Lipoma: a ‘‘reversed’’ perineal sciatic hernia. Am J Surg 107:883–884 (p 231) 20. Singh I, Hudson JE, Richards KA, Hemal AK (2011) Robot assisted laparoscopic repair of sciatic hernia (RASH): a case report. Indian J Surg 73(6):467–469
CASE REPORT
Giant gluteal lipoma presenting as a sciatic hernia A. Dulskas • E. Poskus • S. Jurevicius K. Strupas
•
Received: 23 February 2013 / Accepted: 31 October 2013 Ó Springer-Verlag France 2013
Abstract Background Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. Case presentation A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms—6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. Conclusion The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.
A. Dulskas (&) E. Poskus S. Jurevicius K. Strupas Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University Hospital, Santariskiu Clinics, 2 Santariskiu Street, 08661 Vilnius, Lithuania e-mail: [email protected]
Keywords Sciatic hernia Gluteal hernia Lipoma Retroperitoneal Pelvic floor
Introduction Hernias of the pelvic floor are extremely rare and often present diagnostic and therapeutic dilemmas. Three main types of pelvic floor hernias have been described including, in order of decreasing frequency, obturator, perineal and sciatic. Sciatic hernias are considered the rarest, with a very limited number of published reports worldwide. The sciatic hernia was first described by Papen in 1750 [1]. These hernias are of three types. Type 1 (suprapiriform) is the most common (60 %), followed by subpiriform, type 2 (30 %), while type 3 (subspinous—through the lesser sciatic foramen) is the least common [2, 3] (Fig. 1). We present a case of gluteal lipoma protruding into retroperitoneum with symptoms of compression.
Case report A 53-year-old male presented with an expanding, slightly reducible, painful right gluteal mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, intermittent, other symptoms—around 6 months. No spinal pathology was found on X-ray. There was no history of abdominal surgery of any type. On examination, patient looked well-nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Laboratory tests revealed no changes. CT
123
Hernia
1. 2. 3. 4. 5. 6.
Piriform muscle. Sacrospinous lig. Sacrotuberous lig. Suprapiriform aperture. Infrapiriform aperture. Lesser sciatic foramen.
Fig. 3 Intraoperative view of lipoma displacing right common iliac artery and right ureter anteriously
Fig. 1 Anatomic locations of sciatic hernias. 1 Piriform muscle, 2 Sacrospinous lig, 3 Sacrotuberous lig, 4 Suprapiriform aperture, 5 Infrapiriform aperture, 6 Lesser sciatic foramen
1. Opened endopelvic fascia (reflection). 2. Hernia. 3. Piriform muscle. Fig. 4 Transabdominal approach: schematic view. 1 Opened endopelvic fascia (reflection), 2 Hernia, 3 Piriform muscle
Fig. 2 Gluteal lipoma protruding into retroperitoneum
scan demonstrated a large, well-defined right gluteal fatty mass. The mass was 124 9 55 9 182 mm in size. It was located behind right gluteus maximus muscle, between superior gemellus and internal obturator muscles. Traveling through the greater sciatic foramen it displaced the rectum to the left, right common iliac artery and right ureter anteriously (Fig. 2). The tumor was homogeneously isointense with fat. Elective surgery was done through a lower middle laparotomy approach. To fully reduce the
123
tumor back into the pelvic cavity (via the greater sciatic foramen) and maintain its position there, an assistant was employed to exert external manual pressure on the right buttock throughout the procedure. The tumor was surgically removed (Fig. 3). Few sutures were placed on piriform muscle defect. The sciatic foramen was covered by a patch of endopelvic fascia (Figs. 4, 5). Subsequent pathological examination revealed the tumor as a lobulated mass of adipose tissue measuring 120 9 95 9 35 mm (Fig. 6). Histopathological examination revealed fatty tissue cells with fibric strings and vessels. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery.
Hernia
1. Sutures closing piriform muscle defect. 2. Sutures on endopelvic fascia.
Fig. 5 Transabdominal approach: scheme of covering the defect. 1 Sutures closing piriform muscle defect, 2 Sutures on endopelvic fascia
Discussion Lipomas are a benign variant of liposarcomas located in the peritoneal cavity, and especially in retroperitoneum. They are exceptionally rare, judging by reports published on this matter. Usually they are asymptomatic, because of slow growth. Symptoms appear late and have non-specific features [4]. Sciatic hernia is an extremely rare diagnosis. It occurs in both children and adults, with a female predomination in the adult cases [5–7]. This may be explained with larger pelvis and sciatic foramina in women [8]. There is still ongoing discussion about the etiology of this rare condition. Some authors believe that the neuromuscular diseases, hip pathology causing atrophy of piriform muscle are the main factors [1, 4]. Other theories have suggested increased intra-abdominal pressure, adhesions [5], congenital anomalies or fascial defects [8] as possible causes. The sciatic notch on the inferior margin of the pelvis is divided into the greater and lesser sciatic foramina by the sacrospinous and sacrotuberous ligaments. The greater sciatic foramen is subdivided by piriform muscle into suprapiriformis and infrapiriformis foramen. Sciatic hernias may emerge through either the supra- or infra-piriform spaces or through the lesser sciatic foramen. Patients often complaint of various extent and localization pain: from acute to chronic pelvic [7], back, perineal, buttock or radiating to thigh. Our patient was complaining of lower back, buttock pain; dull pressure in lower abdomen (pelvis) and perineum. Sciatic hernias may present as gluteal mass [5, 10–12], causing sciatica, or with complications of their content. Such contents can include small/large bowel— causing intermittent or progressive intestinal distention, with nausea and vomiting [3, 8, 10–14], the ureter or bladder— causing ureteric colic or urinary sepsis [6, 9, 13–17], ovaries
Fig. 6 Removed lipoma—gross specimen
and fallopian tubes causing pelvic pain [7, 18]. Other documented components of hernia sac are omentum, Meckel’s diverticulum [1], appendical carcinoma, angiomyxoma, lipoma [5, 11, 12, 19]. To our knowledge, there were only four previous descriptions of lipoma herniating through the sciatic foramen. Sciatic hernia can also lead to abscess formation in the gluteal region, particularly after perforation of strangulated bowel [13]. Diagnosis is rare on physical examination because of thickness of overlying tissues. Sometimes palpable mass, deforming gluteal region may be seen. In our patient it was a few centimeters palpable, painless lipoma-like mass in the right gluteus. It was slightly reducible. Sometimes intravenous pyelography, enterography/proctography, cystography, ultrasound, plain X-ray may be used. But today CT scan and MRI are preferred as preoperative diagnostic modalities. In our case, CT scan demonstrated a large, well-defined 124 9 55 9 182 mm right gluteal fatty mass behind right gluteus maximus muscle, between the superior gemellus muscle and internal obturator muscle traversing the greater sciatic foramen displacing rectum to the left, bladder, right common iliac artery and right ureter anteriously (Figs. 2, 3, 4). The tumor was homogenously isointense with fat. Sometimes sciatic hernia may be an accidental finding during other procedure [20]. Repair was historically through a midline transabdominal, transgluteal or combined approach followed by direct suture [1, 4, 7, 12, 13, 15]. Transabdominal approach is recommended in patients who present with bowel incarceration or strangulation [1] (Fig. 4). Free fascial flaps, non-absorbable sutures, prosthetic mesh (Gore-tex, polypropylene), plug, patch, plug and patch may be used for larger hernias in the absence of contamination [1, 3, 7, 12– 14]. The mesh is preferably positioned in the extraperitoneal space—for reducing the incidence of intra-abdominal adhesions which can cause nerve entrapment or bowel
123
Hernia Conflict of interest
I (we) certify that there is no conflict of interest.
References
1. 2. 3. 4. 5. 6. 7. 8. 9.
Gluteus maximus muscle (cut). Gluteus medius muscle. Piriform muscle. Suprapiriform aperture. Infrapiriform aperture. Lesser sciatic foramen. Sacrospinouslig. Sacrotuberouslig. Sciatic nerve.
Fig. 7 Transgluteal approach. 1 Gluteus maximus muscle (cut), 2 Gluteus medius muscle, 3 Piriform muscle, 4 Suprapiriform aperture, 5 Infrapiriform aperture, 6 Lesser sciatic foramen, 7 Sacrospinous lig, 8 Sacrotuberous lig, 9 Sciatic nerve
obstruction [1, 6, 14]. The mesh can be anchored to the periosteum of the inner side of the pubis, laterally to the arcuate line of the ilium, medially to the levator ani muscle, and posteriorly to the periosteum of the sacrum [1]. Anchoring of the prosthesis to the peritoneum brings the risk of injury to the underlying nerves and vessels [6]. Miklos et al. [7] reported their successful experience with the laparoscopic treatment of sciatic hernia in their female patients. Singh et al. [20] reported a successful robotassisted laparoscopic repair of sciatic hernia. Alternatively a transgluteal approach can be used [15]. It is accomplished through the gluteus maximus muscle (Fig. 7). The muscle can be split along a line that connects the major trochanter and the middle portion of the sacrum, corresponding to the course of the piriform muscle [2, 11]. This approach presents significant risks of iatrogenic neurovascular injury, especially if the hernia is large, or complicated by tissue fibrosis obscuring the anatomic planes. However, it can be very useful as part of a combined operation (abdominal and gluteal) to facilitate identification and reduction of the hernia, or to permit complete resection of a retroperitoneal tumor that protrudes from the retroperitoneum through the sciatic foramen [4]. Unfortunately, there are no long-term data comparing different repair types [1]. In our case, transabdominal approach was chosen. The tumor was surgically removed. The sciatic foramen was covered by a patch of endopelvic fascia.
123
1. Losanoff JE, Basson MD, Gruber SA, Weaver DW (2010) Sciatic hernia: a comprehensive review of the world literature (1900–2008). Am J Surg 199(1):52–59 2. Summers JE (1922) Sciatic hernia. Ann Surg 75(6):672–676 3. Rather SA, Dar TI, Malik AA, Parray FQ, Ahmad M, Asrar S (2011) Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report. Ulus Travma Acil Cerrahi Derg 17(3):277–279 4. Singh G, Bharadwaj RN, Purandare SN, Gore CR, Dubhashi SP, Vaidya S, Patil A, Kompally GR (2011) Giant retroperitoneal lipoma presenting as inguinal hernia. Indian J Surg 73(3): 187–189 5. Skipworth RJE, Smith GHM, Stewart KJ, Anderson DN (2006) The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia. World J Surg Oncol 4:33–41 6. Weintraub JL, Pappas GM, Romano WJ, Kirsch MJ, Spencer W (2000) Percutaneous reduction of ureterosciatic hernia. AJR Am J Roentgenol 177:181–182 7. Miklos J, O’reilly M, Saye WB (1998) Sciatic hernia as a cause of chronic pelvic pain in women. Obster Gynecol 91:998–1001 8. Ghahremani GG, Michael AS (1999) Sciatic hernia with incarcerated ileum: CT and radiographic diagnosis. Gastrointest Radiol 16:120–122 9. Tsai P, Lin J, Wu TT, Tsai C (2008) Ureterosciatic hernia causes obstructive uropathy. J Chin Med Assoc 71(9):491–493 10. Servant CTJ (1998) An unusual cause of sciatica: a case report. Spine 23:2134–2136 11. Guerado E, Aguiar F (2006) Rectum compression by a gluteal lipoma. Lancet 368:1893 12. Fernandez EML et al (2012) Intermuscular lipoma of the gluteus muscles compressing the sciatic nerve: an inverted sciatic hernia. J Neurosurg 117(4):795–799 13. Yu PC, Ko SF, Lee TY, Ng S, Huang CC, Wan YL (2002) Small bowel obstruction due to incarcerated sciatic hernia: ultrasound diagnosis. Br J Radiol 75:381–383 14. Chitranjan, Kandpal H, Madhusudhan KS (2010) Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. Br J Radiol 83(987):65–66 15. Chaudhuri A, Chye KK, Marsh SK (1999) Sciatic hernias: choice of optimal prosthetic repair material in preventing long-term morbidity. Hernia 4:229.Her–231.Her 16. Tokunaga M, Shirabe K, Yamashita N, Hiki N, Yamaguchi T (2008) Bowel obstruction due to sciatic hernia. Dig Surg 25:185–186 17. Witney-Smith C, Undre S, Salter V, AL-Akraa M (2007) An unusual case of a ureteric hernia into the sciatic foramen causing urinary sepsis: successfully treated laparoscopically. Ann R Coll Surg Engl 89:1–3 18. Bernard AC, Lee C, Hoskins J, Lee J, Patel S, Ginn G, Maley B (2010) Sciatic hernia: laparoscopic repair with plug and transabdominal extraperitoneal patch. Hernia 14:97–100 19. Kerry RL, Tygart RL, Glass WW (1964) Lipoma: a ‘‘reversed’’ perineal sciatic hernia. Am J Surg 107:883–884 (p 231) 20. Singh I, Hudson JE, Richards KA, Hemal AK (2011) Robot assisted laparoscopic repair of sciatic hernia (RASH): a case report. Indian J Surg 73(6):467–469
