Sciatic hernia with incarcerated urinary bladder: Laparoscopic transabdominal extraperitoneal repair with a mesh plug

Abstract

An 87-year-old man experiencing abrupt and severe lower abdominal pain was found to have a pulsatile right hip mass. An abdominal computed tomography scan demonstrated that a portion of the redundant urinary bladder was herniating through the right sciatic foramen and into the right gluteus maximus muscle. Laparoscopic transabdominal extraperitoneal repair with a synthetic mesh plug was performed. The patient recovered uneventfully, without recurrence during 3 years of follow-up. The pathogenesis, clinical manifestation, imaging studies, and treatment of sciatic hernia were reviewed.

Bilateral sciatic hernias in an elderly woman successfully managed with robotic surgery: A case report and literature review

“…The clinical symptoms of a sciatic hernia can vary depending on the structure that is entrapped in the sciatic notch, potentially consisting of various structures including ovaries, ureters, bladder, small and large intestine [1] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] However, approximately half of patients complain of non-specific abdominal and pelvic pain and only one-third have a mass appreciated on physical exam [3] . Feeling for a small hernia in the location of the sciatic notch may not be intuitive in a patient presenting with nonspecific complaints.…”

“…In the absence of strangulation, the mass is reducible and audible bowel sounds have been reported [7] , [8] . If the ureter is involved, patient can develop associated hydronephrosis and hydroureter, causing obstructive renal disease [1] , [11] , [12] . Involvement of the urinary bladder has been associated with increasing abdominal pain, urinary urgency, and inability to fully void, especially after bouts of coughing [11] .…”

“…If the ureter is involved, patient can develop associated hydronephrosis and hydroureter, causing obstructive renal disease [1] , [11] , [12] . Involvement of the urinary bladder has been associated with increasing abdominal pain, urinary urgency, and inability to fully void, especially after bouts of coughing [11] . Herniation of the ovary or fallopian tube has been shown to cause chronic pelvic pain syndrome in females [9] .…”

“…The mainstay treatment of sciatic hernias, regardless of incarceration, is surgical reduction and repair because the risk of strangulation is high [1] , [4] , [5] . A notable exception is when the ureter is the structure involved, which has been repaired solely with stent placements [11] , [12] . With intestinal involvement, there have been reports of transabdominal and transgluteal operative approaches via laparoscopic repair [14] .…”