Giant gluteal lipoma presenting as a sciatic hernia

Area of Science:

• General Surgery
• Pelvic Floor Disorders
• Hernia Surgery

Background:

• Sciatic hernias are exceptionally rare pelvic floor hernias, with limited global case reports.
• Lipomas within hernia sacs are unique pathologies, further increasing the rarity of such presentations.

Observation:

• A 53-year-old male presented with a painful, expanding gluteal mass, lower abdominal pressure, and urinary/defecatory urgency.
• Imaging revealed a large intra- and extra-pelvic fatty mass extending through the greater sciatic foramen.
• Physical examination identified a reducible gluteal lump, with no spinal pathology detected.

Findings:

• The case involved a gluteal lipoma presenting as a sciatic hernia, displacing pelvic structures like the rectum and bladder.
• Surgical excision via laparotomy successfully removed the lipoma.
• Pathological examination confirmed the mass as a lipoma.

Implications:

• This case underscores that a gluteal mass should prompt consideration of sciatic hernia.
• Early diagnosis and surgical intervention are crucial for managing rare hernias and associated masses.