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

TL;DR

A rare sciatic hernia was misdiagnosed as gluteal pain in an elderly woman, emphasizing the need for imaging to detect such uncommon conditions.

Contribution

This case report highlights the diagnostic challenge of sciatic hernias and advocates for tailored surgical approaches in high-risk patients.

Findings

CT imaging confirmed a left-sided sciatic hernia involving the sigmoid colon in a 68-year-old woman.

A tailored surgical approach minimized operative time and complications in a high-risk patient.

Sciatic hernias can mimic common conditions like sciatica or diverticulitis, leading to delayed diagnosis.

Abstract

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.

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