Sciatic Hernia Research Articles

EP612 - Laparoscopic repair of sciatic hernia: A demonstrative case on minimally invasive technique

Abstract Background Sciatic hernias are rare pelvic hernias that pose significant diagnostic and therapeutic challenges. A minimally invasive approach to repairing these defects offers the potential for reduced morbidity and quicker recovery. This report aims to highlight the feasibility, safety and provide an illustrative demonstration of the laparoscopic repair of a sciatic hernia. Methods A 72-year-old asymptomatic female diagnosed with a sciatic hernia underwent elective laparoscopic hernia repair as a day case. The preoperative evaluation, surgical technique and operative outcomes are detailed. Results A right-sided sciatic hernia containing a loop of the small bowel was diagnosed on cross-sectional imaging. Laparoscopically, a pre-peritoneal space in the right ovarian fossa was established, the hernia defect was delineated, and repair was performed using a polypropylene mesh prosthesis. No intraoperative or immediate postoperative adverse outcomes were reported. The patient was discharged on the same day, experiencing minimal discomfort, with a plan for outpatient follow-up. The literature on sciatic hernia repair is limited, and multiple operative techniques have been described. This report includes a step-by-step pictorial description of the laparoscopic sciatic hernia repair. Conclusion Laparoscopic repair of sciatic hernias can be performed safely and effectively, offering advantages such as reduced pain and faster recovery. This case underscores the importance of considering laparoscopic approaches for managing complex and rare hernias in the elderly population, emphasising tailored surgical planning and skilled execution.

A rare case report of inverse sciatic hernia unveiling as a lipoma

Abstract When a swelling arising in the gluteal region herniates into the pelvic cavity through the sciatic foramen, it is referred to as inverse or reverse sciatic hernia and is a rare occurrence. We present the case of a 62-year-old female who presented with swelling in the left gluteal region with features of sciatica and abdominal pain. Magnetic resonance imaging showed 27 cm × 22 cm × 9 cm soft tissue swelling arising from the gluteal region and inversely herniating into the pelvic cavity through the sciatic foramen. We were successful in delivering the tumor through a gluteal approach. Lipomatous tumors presenting as inverse sciatic hernia are a rare event.

Giant gluteal lipoma presenting as sciatic hernia: a case description

Giant gluteal lipoma presenting as sciatic hernia: a case description

LINDBLOM HERNIA: URETER INCARCERATION IN LEFT SCIATIC FORAMEN. LAPAROSCOPIC APPROACH

Abstract Background Sciatic hernias are thought to be secondary to a partial loss of pelvic fascia, atrophy of the piriformis, congenital deformity, or a combination of either. Hernia sac may contain small bowel, ureter, ovary, colon or bladder. Patients may have diverse symptoms and signs ranging from abdominal or pelvic pain or with complications due to incarceration of their contents such as ureteric or bowel obstruction. The Curlicue sign is described as ureteric obstruction with U-shaped tortuosity through the sciatic foramen which is pathognomonic of uretero-sciatic hernia. Various surgical approaches have been reported in the literature, from open laparotomy, abdominoperineal/trans-gluteal approach, to laparoscopy and minimally invasive approach to repair it. The defect can be repaired with a mesh, non-absorbable sutures, and reinforced with a peritoneal flap or epiplon. Method We describe a laparoscopic approach of a left-sided ureterosciatic hernia (Lindblom hernia) who associate an ipsilateral inguinal and obturator defect. Results 80-year-old female come to our center with left flank pain associated with a decline in renal function. A CT scan showed severe left-sided hydro-nephrosis, and the diagnosis of Lindblom hernia was made. A JJ tube was inserted, which relieved the obstruction and improved the renal function preoperatory. A laparoscopic approach via TAPP was perform and the patient was discharged without complications in 24 hours. Conclusion Sciatic hernia are a rare cause of chronic pelvic pain and various surgical approaches have been reported to repair it.

A Case of Laparoscopic Repair of Left Sciatic Hernia with Coexisting Femoral and Obturator Hernias

A Case of Laparoscopic Repair of Left Sciatic Hernia with Coexisting Femoral and Obturator Hernias

A Case of a Greater Sciatic Hernia Coexisting with an Obturator Hernia Treated with Elective Laparoscopic Surgery after Manual Reduction of Both Hernias

症例は89歳の女性で，嘔吐を主訴に救急外来を受診した．腹部CTで大坐骨孔ヘルニア嵌頓，閉鎖孔ヘルニア嵌頓により腸閉塞に陥っていたが用手整復により腸閉塞を改善させた．待機的に腹腔鏡下で大坐骨孔ヘルニア，閉鎖孔ヘルニアを1枚のシート状メッシュを用いて，閉鎖神経を通過させるスリットを作成し同時修復した．閉鎖孔には閉鎖神経，動静脈が通過し，大坐骨孔周囲には尿管や坐骨神経，上下殿動脈などが走行するためこれらを損傷しないように注意が必要である．感染の危険がない場合には，腹腔鏡下のメッシュによる修復は，有効な治療法となりうると思われたので報告する．

Incidentally Discovered Sciatic Hernia Treated with Laparoscopic Mesh Repair—A Case Report and Literature Review—

Incidentally Discovered Sciatic Hernia Treated with Laparoscopic Mesh Repair—A Case Report and Literature Review—

Laparoscopic repair of sciatic hernia recognizing the ureterohypogastric nerve fascia and vesicohypogastric fascia: a case report

BackgroundSciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment.Case presentationHere we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery.ConclusionA laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

BackgroundUreterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options.Case presentationWe report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved.ConclusionsAlthough ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

1669 Ureterosciatic Hernia: A Case Report and Review of the Literature

Abstract Aim Ureterosciatic hernia (USH) is an extremely unusual condition, with presentations ranging from asymptomatic, to flank pain, renal failure, septic shock and even obstructive uropathy. Due to its rarity, there are no recommendations on the treatment of USH. We therefore carried out a systemic review of published literature on its management. Method The systemic review was completed using three search terms: “uretero sciatic hernia”, “ureterosciatic hernia” and “ureteric sciatic hernia” on Healthcare Databases Advanced Search, producing 224 potential papers. This was narrowed down to 42 papers after using the PRISMA guidelines. All selected papers included a case report of USH, as well as the investigation and management in English only. Result We report a case of an 85-year-old female who was investigated for weight lost with Computed Tomography(CT), which showed an incidental finding of USH. She was managed conservatively after she denied any symptoms and had no hydronephrosis. Abdominal pain was the most common presentation of USH(64%), whilst only 9.5% were found incidentally. 79% of all patients had a CT scan which showed the pathognomonic “curlicue” sign. 55% of all patients had hydronephrosis. Half of all patients had surgical intervention, from open repair to laparoscopic to robotic(9.5% of all management)with no known mortality. Conservatively management(16.6%) was reserved for asymptomatic/poor surgical candidates, and were more likely to be followed up compared to surgical patients(55.5%vs47.6%). Conclusions Our case is of an incidental USH managed conservatively, with a literature review emphasising similarities to our case and the different management options.

Bilateral sciatic hernias in an elderly woman successfully managed with robotic surgery: A case report and literature review.

IntroductionSciatic hernias are the rarest form of pelvic floor hernias as well as an uncommon cause of sciatica. A high index of suspicion is required to make the diagnosis due to its variable clinical presentation. This is the first case describing bilateral intestinal sciatic hernia, diagnosis, and robotic surgical repair.Presentation of caseA 77-year-old female with history of chronic back pain and diverticulitis presented with three weeks of abdominal pain, radiating down her legs bilaterally. Computed tomography (CT) revealed bilateral sciatic notch hernias without evidence of bowel obstruction. Magnetic resonance imaging (MRI) confirmed compression of the sciatic nerves within the sciatic notch bilaterally. She underwent robotic bilateral retroperitoneal sciatic notch hernia repair successfully.DiscussionThere are several independent causes of abdominal pain and bilateral radiating leg pain. Sciatic hernias are an unusual cause of both. Aside from bowel, the hernia can involve other structures, such as the bladder, ureters, or ovaries, potentially creating drastically different clinical pictures. Laparoscopic or robotic repair have been proven superior to open surgery in the literature.ConclusionThis case demonstrates that bilateral sciatic hernias can present as uncomplicated sciatica in an elderly patient, but the addition of seemingly unrelated abdominal pain should warrant further investigation. Minimally invasive robotic repair can successfully treat sciatic hernias.

Case Report: An Encapsulated Mass of the Gluteal Region Found During Cadaveric Dissection

We describe a large, encapsulated mass containing friable tissue – likely a partially healed hematoma or abscess – in the right gluteal region of a 93-year-old female cadaver, which potentially caused impaired function of the ipsilateral tensor fasciae latae. We first observed this mass between the right gluteus medius and gluteus minimus muscles during dissection lab for the Physical Therapy DPT students. This structure was roughly circular (~11 cm in maximum width) and completely encapsulated by dense connective tissue. Since the inferior aspect appeared to pass through the sciatic foramen, we hypothesized that this was caused by a sciatic hernia. However, this was rejected based on the later dissection of the abdominal and pelvic cavities. None of the structures that can potentially cause a sciatic hernia – colon, ovaries, uterine tube, ureter – were protruding through the sciatic foramen. Additionally, dissection of the gluteal region revealed that the dense connective tissue covering the mass was not passing through the sciatic foramen, rather it was adhered to the ilium near the greater sciatic notch. Dissection of the structure itself showed that its margins were limited to the borders of the gluteus medius and it was composed of two layers of dense connective tissue with clear fluid between them. The outer layer of connective tissue had the appearance of thickened intermuscular fascia. Within the second layer, completely encapsulated, was friable tissue. This suite of characteristics is consistent with a partially healed intermuscular hematoma or abscess, but the pathologic diagnoses of this mass cannot be confirmed without histologic evaluation. Intermuscular hematomas and abscesses in the gluteal region can be caused by traumatic damage to the superior gluteal artery, trigger point injections, and hip arthroplasty. A plausible side effect of this mass lesion is compromised function of the superior gluteal nerve and artery. The tensor fasciae latae on the right side was 9.6% shorter and 13.4% lower in mass than on the left side. There was symmetry and no evidence of degeneration to the gluteus medius and gluteus minimus muscles, so it is possible that there was only a disruption to the innervation or blood supply to the ipsilateral tensor fasciae latae.

A CASE OF AGGRESSIVE ANGIOMYXOMA. DIFFERENTIAL DIAGNOSIS OF ABANDONED NONORGAN ORGAN TUMORS (LITERATURE REVIEW WITH THEIR OWN CLINICAL OBSERVATIONS)

Aggressive angiomyxoma is a rare pelvic-perineal tumor that affects mainly women aged 30-50 years. It can simulate a bartholine cyst, abscess, lipoma, simple labial cyst or other soft tissue tumors of the pelvis. The main features of angiomyxoma are asymptomatic course and absence of metastasis in the presence of a tendency to deep invasion and relapses after surgical treatment. The article describes a clinical case of aggressive angiomyxoma in a 33-year-old patient who was admitted to the emergency hospital with a suspected right sciatic hernia. According to the results of clinical and radiological examination the formation of presacral space was detected spreading to the m. levator ani on the right and into the tissue of the right ischiorectal fossa, infiltrating them. The specific features couldnt be identified using formal signs which are distinctive for specific type of neoplasms at initial stage of the diagnosis. The diagnosis was made as a result of morphological analysis of the resection material of the tumor after surgery. The relapse wasnt detected in the following 6 months. Assuming the high risk of angiomix progression the dynamic monitoring was continued. This study and literature data have demonstrated the typical difficulties of differential diagnosis and prognosis of the disease, the need for a comprehensive approach using multiparametric magnetic resonance imaging, both at the initial stages of the examination and in monitoring the effectiveness of treatment.

Successful Laparoscopic Repair of Sciatic Hernia in a Super–elderly Patient

Successful Laparoscopic Repair of Sciatic Hernia in a Super–elderly Patient

A Case of Sciatic Hernia Co-existing with an Inguinal Hernia

A Case of Sciatic Hernia Co-existing with an Inguinal Hernia

A Giant Sciatic Hernia

A Giant Sciatic Hernia

腹腔鏡下に修復した坐骨ヘルニアの1例

症例は77歳，女性．1カ月前からの下腹部違和感を主訴に近医を受診．整腸剤の処方受けるも改善なく当院を受診．腹部CTにて骨盤内において右坐骨孔より脱出する小腸を認め，大坐骨孔ヘルニアと診断．腸閉塞の合併はなく，血液検査でも異常所見は認めなかったが，その後も症状が持続するため待機的に手術の方針となった．手術は腹腔鏡下に施行し，上殿動脈に沿ってヘルニア門を認め大坐骨孔（梨状筋上孔）ヘルニアと術中診断．ヘルニア門にmesh plug，後腹膜腔にonlay patchを留置して腹腔鏡下に修復した．坐骨ヘルニアは極めて稀なヘルニアであり，腹腔鏡下に修復したという報告も少ないため，若干の文献的考察を加えて報告する．

Laparoscopic repair for ureteral sciatic hernia

Laparoscopic repair for ureteral sciatic hernia

Recurrent ureteric sciatic hernia

Recurrent ureteric sciatic hernia

閉鎖孔ヘルニアに併存していた坐骨ヘルニアの1例

坐骨ヘルニアは，坐骨孔より脱出するヘルニアであり，閉鎖孔ヘルニアとともに骨盤底ヘルニアに分類されている．今回われわれは，閉鎖孔ヘルニアに併存していた坐骨ヘルニアの1例を経験した．症例は93歳，女性．右臀部から大腿背側にかけての疼痛，腹部膨満，嘔吐を主訴に受診した．腹部CT検査にて，右閉鎖孔ヘルニア嵌頓とそれに伴う小腸イレウス，右坐骨ヘルニアと診断し，手術を施行した．右閉鎖孔に小腸が嵌頓し壊死していたため，小腸部分切除術を施行した．右坐骨孔の小腸の嵌入は開腹時に自然整復されており，ヘルニア嚢の奥に傍卵巣嚢腫の嵌入を認め嚢腫切除術を施行した．右閉鎖孔・右坐骨孔は単純閉鎖した．閉鎖孔ヘルニアと坐骨ヘルニアは，骨盤底筋群の脆弱化という同様の機序がある．坐骨ヘルニアはすべてのヘルニアの中で最も稀と報告されているが，無症候性の場合もあり，両疾患の合併を念頭に置いた診断・治療が必要であると考えられた．