Abstract
The case concerns a forty-year-old patient with adenomyosis, metrorrhagia, and typical sciatic pain during menstruation. After the insertion of an LNG-IUD, the bleeding stopped, but the sciatic pain persisted. MRI revealed an endometriotic nodule in the region of the sciatic nerve. The patient underwent successful laparoscopic surgery according to all principles of retroperitoneal pelvic surgery at the Reference Center for Endometriosis and made a full recovery.
Keywords: Sciatic nerve endometriosis, Retroperitoneal pelvic laparoscopy
Presentation
A 40-year-old patient with a history of two normal vaginal deliveries reported heavy menstrual bleeding and dysmenorrhea for 2 years, along with typical sciatic symptoms during menstruation. During evaluation, adenomyosis was suspected, and a levonorgestrel-releasing intrauterine device (LNG-IUD) was prescribed, which resolved the bleeding and dysmenorrhea. However, sciatic symptoms persisted, with pain (VAS score 9/10) radiating posterolaterally to the right thigh and lower leg down to the heel, accompanied by significant atrophy of the thigh muscles. Ultrasound findings indicated adenomyosis, and an MRI of the lumbosacral spine was normal. However, a pelvic MRI revealed a mixed signal 2.5 cm in the area of the right sciatic nerve at its exit from the pelvis, below the right greater trochanter. After complete preoperative preparation, a laparoscopic surgery was performed. An endometriotic cystic nodule above the sciatic nerve at its pelvic exit was excised, which was compressing the nerve without infiltration. The patient was discharged on the third postoperative day. Postoperatively, dienogest was prescribed for 6 months. During 2 years of follow-up, the patient underwent physical therapy and reported feeling well, with restored muscle strength in the right leg.
Discussion
In patients with sciatic nerve endometriosis, two key points should be emphasized. First, the importance of timely diagnosis to prevent extensive nerve damage that could lead to foot drop [1]. Second, the advantage of laparoscopic surgery, performed according to the principles of retroperitoneal surgery with thorough knowledge of pelvic anatomy [2, 3]. The significance of intensive postoperative physiotherapy in severe cases for complete nerve recovery should also be highlighted [3]. In our patient, there was no perineural nerve infiltration, only external compression, with symptoms lasting less than 2 years. The surgery was performed following all principles of retroperitoneal pelvic surgery with a good understanding of pelvic anatomy, indicating a successful postoperative recovery (Fig. 1).
Fig. 1.
Active endometriosis at the level of the right sciatic nerve
Author contributions
M.Ć—wrote the manuscript and performed the surgery on the patient. A.J.K.—performed radiological evaluation of the patient—pelvic MRI.
Funding
The authors have not disclosed any funding.
Data availability
No datasets were generated or analyzed during the current study.
Declarations
Conflict of interest
The authors declare no competing interests.
Footnotes
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References
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Associated Data
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Data Availability Statement
No datasets were generated or analyzed during the current study.