The Hidden Hernia: A Rare Sciatic Hernia Masquerading as Gluteal Pain in an Elderly Woman

Sciatic hernias are one of the rarest pelvic floor hernias and a highly uncommon cause of gluteal or abdominal pain. Their variable presentation often delays diagnosis, particularly in frail patients. We report a case of a 68-year-old woman with severe chronic obstructive pulmonary disease and chronic comorbidities who presented with vague abdominal and gluteal pain. CT imaging revealed a left-sided sciatic hernia involving the sigmoid colon without obstruction. She underwent a successful open hernia reduction and sigmoidopexy, avoiding mesh due to high operative risk. Sciatic hernias can mimic common conditions like diverticulitis or sciatica. Imaging is essential for diagnosis, especially in high-risk patients. In this case, a tailored surgical approach minimized operative time and complications. This case highlights the importance of considering sciatic hernias in elderly patients with nonspecific pelvic or gluteal symptoms. Early imaging and individualized management are key to optimizing outcomes.