Early radiologic diagnosis and laparoscopic transabdominal pre-peritoneal repair of a rare adnexal sciatic hernia: A case report

Sciatic hernias containing adnexa are exceedingly rare and prone to misdiagnosis. This study reports the case of an 84-year-old multiparous female (body mass index: 18 kg/m 2 ) who presented with acute right lower abdominal pain. Initially, the patient was misdiagnosed clinically with an obturator hernia; however, rigorous multidisciplinary computed tomography re-evaluation confirmed a right-sided adnexal sciatic hernia. Laparoscopic exploration revealed the adnexa and a mesosalpingeal cyst herniating through a 2.0-cm suprapiriform defect. Given her advanced age and the mechanical risk posed by the cyst, a right salpingo-oophorectomy was justified. The defect was concurrently repaired using a transabdominal pre-peritoneal approach, with the mesh secured solely by continuous peritoneal suturing. Prior to mesh placement, the ureter was mobilised medially to maintain a safe distance from the repair site. The post-operative course was uneventful, and she was discharged on day seven. This case highlights the crucial role of accurate radiological differential diagnosis in high-risk women and demonstrates a safe, minimally invasive management strategy.