Intermuscular lipoma of the gluteus muscles compressing the sciatic nerve: an inverted sciatic hernia

Case report

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The authors report the case of a 50-year-old woman with a benign intermuscular lipoma of the gluteus compressing the sciatic nerve in its course through the sciatic notch. This benign soft-tissue tumor extended into the pelvis, displacing the rectum laterally. Resection was necessary to alleviate symptoms and prevent irreversible damage of the nerve. Wide exposure of the piriformis muscle and sciatic nerve via a transgluteal approach allowed safe lesion removal, and thus avoiding a laparotomy to resect the intrapelvic extension of the tumor. This report features a curious case of soft-tissue tumor growth across the sciatic foramen forming an inverted sciatic hernia. The authors' proposed approach was simple and safe and avoided a laparotomy.

Article Information

Address correspondence to: Eudaldo López-Tomassetti Fernández, M.D., Department of Surgery, Avenida Marítima del Sur, s/n, Las Palmas, Las Palmas de Gran Canaria 35016, Spain. email: dretomassetti@gmail.com.

Please include this information when citing this paper: published online August 17, 2012; DOI: 10.3171/2012.7.JNS111714.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Computed tomography scan showing a lipoma herniating through the sciatic foramen. Arrow indicates extrinsic compression of the rectum by the mass. B: Computed tomography scan demonstrating extrinsic compression of the rectum by the mass. Arrow indicates the lipoma herniating through the sciatic foramen. C: Computed tomography scan showing no extension of the mass lesion beyond the confines of the pelvis and intramuscular gluteus (dotted black line).

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    Upper: Computed tomography scan showing a well-delimited intermuscular lipoma (arrow). Lower: Coronal CT demonstrating herniation (arrows).

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    A: Schematic indicating surgical access gained via a transgluteal approach. B: Schematic showing retraction of the right gluteus maximus muscle. Exposure was maintained using autostatic retractors. C: Schematic depicting surgical exposure of the lipoma. A Foerster clamp provides traction for removal of the mass. Blunt dissection was performed using the finger. With gently sweeping maneuvers, the lipoma was separated from the muscles. Printed with the permission of E. López-Tomassetti Fernández, 2012.

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    Photomicrograph of whole-tissue section of the lipoma showing proliferation of adipose tissue with some fibrous connective tissue. Adipocytes were irregular in size with large vacuolated cytoplasm. Nuclei were barely visible. H & E, original magnification × 10.

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    Computed tomography scans obtained in the patient before (A) and after (B and C) surgery. Although there was lipoma herniation (black line) before surgery (A), there was no sign of recurrence after surgery (B and C). Even though the patient was asymptomatic, there was gluteus medius atrophy.

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