Other hernias

Sciatic hernia

• Herniation through the greater sciatic foramen
• Extremely rare and difficult to diagnose
• Usually asymptomatic until SBO occurs
• Can also get a mass in the gluteal area
• Sciatic nerve pain can occur
• Surgery
  • Trans-peritoneal approach preferred in case of strangulation/obstruction
  • Hernia contents can usually be reduced with gentle traction
  • Trans-gluteal approach is also possible - incise from the posterior edge of the greater trochanter across the hernia mass

Perineal hernia

• Caused by congenital or acquired defects
• Uncommon
• Can occur after APR or perineal prostatectomy
• Hernial sac protrudes through the pelvic diaphragm
• Symptoms usually related to protrusion of a mass through the defect that is worsened by sitting or standing
• May feel bulge on bimanual rectal-vaginal exam
• Repair through transabdominal approach, or combined transabdominal/perineal approach. Close small defects with permanent suture and larger defects with mesh