Combined laparoscopic and gluteal approach for resection of a sciatic notch dumbbell lipoma

The greater sciatic, lesser sciatic and obturator foramina are openings in the pelvis through which pelvic lesions can herniate, leading to the formation of rare dumbbell tumours. We present the case of a man in his late 60s, who presented with obstructed defecation. A per rectal examination revealed a palpable right sided rectal mass. MRI pelvis identified a dumbbell lipoma traversing the right sciatic foramen, with a pelvic component causing displacement of the rectum and a gluteal component impinging on the sciatic nerve. The lipoma was successfully removed by a multidisciplinary team using a dual approach: the pelvic component was excised laparoscopically, and the gluteal component was removed by an open approach. Comprehensive knowledge of pelvic anatomy is required to safely and accurately excise lesions in this region. Laparoscopic approach offers clear advantages over the open approach, while yielding similar results.