An unusual cause of sciatica. A case report.

Abstract

This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. To highlight the need to examine the course of the sciatic nerve for local pathology when the cause of sciatica is not obvious. Sciatic herniae are rare. The coexistence of sciatica and a gluteal abscess, caused by a strangulated sciatic hernia, does not appear to have been reported previously. A 66-year-old woman with preexisting low back pain and left leg pain was admitted to the hospital with intestinal obstruction and a left gluteal mass. Results of needle aspiration suggested the diagnosis, which was confirmed by laparotomy. The sciatic hernia was repaired via a transabdominal approach. The symptoms of sciatic nerve compression and intestinal obstruction resolved fully after surgery. The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.