Endometriosis Involving the Sciatic Nerve: A Case Report of Isolated Endometriosis of the Sciatic Nerve and Review of the Literature

Abstract

Endometriosis is a common gynecological condition which affects 5-10% of women of reproductive age and up to 50% of women with pelvic pain and infertility. The most commonly affected areas are the pelvic peritoneum, ovaries and rectovaginal septum. Isolated endometriosis of the sciatic nerve is very rare. Our patient suffered from worsening right hip and buttock pain with severe exacerbation during menstruation. Several different imaging modalities (ultrasound of her pelvis and right hip, as well as X-rays and computed tomography scans of her right hip and lumbosacral spine) failed to identify any pathology. Magnetic resonance imaging scans of her pelvis revealed a 3.5 cm endometriotic lesion over the pelvic segment of her right sciatic nerve. Following a multidisciplinary discussion, the patient underwent laparoscopic excision of endometriosis. The patient recovered well from her surgery. She successfully conceived with in vitro fertilization 3 years after her surgery, following a failed course of Clomid (Clomiphene citrate) for ovulatory dysfunction.

Keywords: Endometriosis; laparoscopy; pelvic pain; sciatic nerve.

Figure 1

Magnetic resonance imaging of Miss AB, where an endometriotic nodule involving the sciatic nerve can be seen on the right. Atrophic changes in the gluteus minimus and medius can be seen as well

Figure 2

Right pelvic sidewall with right obturator nerve encased with endometriosis

Figure 3

Right pelvic sidewall after having endometriosis excised from right obturator nerve

Figure 4

Right pelvic sidewall demonstrating right sciatic nerve and site where endometriosis was excised