Giant gluteal lipoma presenting as a sciatic hernia

Area of Science:

• General Surgery
• Pelvic Floor Surgery
• Hernia Repair

Background:

• Sciatic hernia is an extremely rare pelvic floor hernia, with fewer than 100 reported cases globally.
• Lipoma within a hernia sac is an exceptionally uncommon finding, with limited documented instances.
• This case presents a gluteal lipoma protruding into the pelvis, causing displacement of the rectum and bladder, mimicking a sciatic hernia.

Purpose of the Study:

• To report a unique case of sciatic hernia caused by a gluteal lipoma.
• To emphasize the diagnostic considerations for gluteal masses presenting as hernias.
• To contribute to the limited literature on sciatic hernias and intrahersac lipomas.

Main Methods:

• A 53-year-old male with a 6-month history of a gluteal mass, back pain, and lower abdominal/perianal pressure was evaluated.
• Imaging with CT scan revealed a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen.
• The mass was surgically excised via a lower middle laparotomy, and pathological examination confirmed it as a lipoma.

Main Results:

• The patient presented with symptoms suggestive of hernia, including a reducible gluteal mass and referred pain.
• CT imaging successfully identified the large fatty mass within the sciatic foramen.
• Surgical intervention led to an uneventful recovery, with the patient discharged after 8 days.

Conclusions:

• A gluteal mass should raise suspicion for a potential sciatic hernia.
• This case underscores the rarity and varied presentations of sciatic hernias.
• Prompt diagnosis and surgical management are crucial for favorable outcomes in such rare conditions.