Sciatica: An Extremely Rare Complication of the Perianal Abscess.
Rahul Gujrathi1, Kanchan Gupta1, Chetan Ravi1
1Department of Radiology, Sevenhills Hospital, Mumbai, India.
Polish Journal of Radiology
|October 14, 2016
Summary
A supralevator perianal abscess can cause sciatica by irritating the sciatic nerve. This case highlights the importance of considering extra-spinal causes when lumbar MRI reveals no abnormalities, especially with STIR sequences.
Area of Science:
- Radiology
- Gastroenterology
- Neurology
Background:
- Sciatica is typically caused by spinal abnormalities compressing the sciatic nerve.
- Magnetic Resonance Imaging (MRI) of the lumbosacral spine is frequently used to diagnose the cause of sciatica.
- Extra-spinal etiologies for sciatica are uncommon and often overlooked.
Observation:
- A patient presented with acute right hip and leg pain, suggestive of sciatica.
- Lumbar spine MRI showed no abnormalities.
- STIR coronal MRI sequences revealed a supralevator perianal abscess tracking along the sciatic nerve.
Findings:
- The perianal abscess was identified as the cause of sciatic nerve irritation and pain.
- Surgical drainage and antibiotics led to symptom resolution.
- Post-operative imaging confirmed abscess resolution and clinical improvement.
Implications:
- This case underscores the need to investigate extra-spinal causes of sciatica when spinal imaging is negative.
- STIR sequences on lumbosacral MRI are crucial for detecting occult extra-spinal pathologies.
- Considering perianal abscesses as a differential diagnosis for sciatica can improve patient outcomes.
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