SCIATIC HERNIA - A RARE TYPE OF HERNIA

Background - Sciatic hernias are considered the rarest pelvic floor hernias, with a very limited number of published reports worldwide. Case report - We report a 43 year old female who presented with a slow growing swelling in the left gluteal region. Examination revealed a soft, partly reducible, swelling with expansile impule on coughing. At laparotomy the cyst was found to be arising between the two layers of the broad ligament and passing through the greater sciatic foramen. The content of the cyst was dark brown fluid. The cyst was excised and a prolene mesh plug was placed in the defect. Histopathology of the cyst showed a simple serous cyst. Conclusions - Sciatic hernia is unusual, and can present with diagnostic and treatment dilemmas. The hernia may present with obscure pelvic pain, intestinal obstruction, lifethreatening gluteal sepsis, or as an asymptomatic, reducible mass that distorts the gluteal fold. Small sciatic hernia can remain hidden behind the gluteus maximus muscle. The diagnosis requires imaging studies in such cases. Treatment of sciatic hernia is always surgical and requires prosthetic reinforcement for the best result.