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Dumb-bell shaped tuberculous abscess across the greater sciatic notch compressing both sciatic nerves
H Baba1, Y Okumura, N Furusawa
1Department of Orthopaedic Surgery, Fukui Medical School, Japan.
Spinal Cord
|August 26, 1998
Summary
A rare tuberculous abscess compressing sciatic nerves bilaterally caused lumbar radiculopathy symptoms. Surgical resection of the dumbbell-shaped abscess provided complete symptom relief, highlighting effective treatment for this unusual presentation.
Area of Science:
- Orthopedics
- Neurosurgery
- Infectious Diseases
Background:
- Tuberculous abscesses can present with atypical symptoms, potentially delaying diagnosis.
- Compression of the sciatic nerve by abscesses is uncommon and can mimic other neurological conditions.
Observation:
- A 65-year-old man presented with a bilateral dumbbell-shaped tuberculous abscess in the greater sciatic notch.
- Symptoms included slow progression mimicking lumbar radiculopathy, leading to diagnostic delays.
- The abscess adhered to the sciatic nerve and surrounding vasculature.
Findings:
- Surgical resection of the tuberculous abscess was performed using anterolateral retroperitoneal and posterolateral gluteal approaches.
- The surgical strategy allowed safe access and complete removal of the abscess.
- Post-operative recovery showed complete resolution of the patient's symptoms.
Implications:
- This case underscores the importance of considering rare etiologies like tuberculous abscesses in patients with sciatica-like symptoms.
- Surgical intervention is effective for relieving sciatic nerve compression caused by such abscesses.
- Multidisciplinary approaches involving orthopedic and infectious disease specialists are crucial for managing complex tuberculous infections.