Delayed sciatic nerve palsy due to a subepineural hematoma following a gluteal gunshot injury: A case report

Gunshot wounds (GSWs) to the lower extremities are common in civilian trauma and may lead to a spectrum of neurovascular complications. While acute sciatic nerve injury is frequently reported, delayed neuropathies—particularly those caused by intraneural or subepineural hematomas—are rare and often underrecognized. We present the case of a 25-year-old male who sustained a gluteal gunshot injury with no initial neurological deficit. The bullet was surgically removed, and the patient was discharged on neuropathic pain medication. Ten days later, he developed progressive paresthesia and new-onset motor weakness involving ankle and toe extension. Magnetic resonance imaging performed 20 days after injury revealed a 12 × 6 mm hematoma compressing the sciatic nerve along the ballistic tract. Surgical exploration confirmed a subepineural hematoma, which was evacuated through epineurotomy. The patient experienced gradual neurological improvement and achieved full motor and sensory recovery at two-year follow-up. Subepineural hematoma causing delayed sciatic nerve palsy represents an uncommon sequela of penetrating trauma. Early recognition of delayed neurological deterioration, prompt imaging, and timely surgical decompression are critical to prevent irreversible nerve damage. Increased awareness of this rare entity may facilitate earlier diagnosis and improve patient outcomes.