Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2022; 10(25): 9028-9035
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.9028
Simultaneous laparoscopic and arthroscopic excision of a huge juxta-articular ganglionic cyst compressing the sciatic nerve: A case report
Won-Ku Choi, Jong-Sung Oh, Sun-Jung Yoon
Won-Ku Choi, Department of Obstetrics and Gynecology, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju 54907, South Korea
Jong-Sung Oh, Sun-Jung Yoon, Department of Orthopedic Surgery, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
Author contributions: Yoon SJ designed, performed the research, edited the manuscript and reviewed the literature; Oh JS, Yoon SJ and Choi WK wrote the manuscript; Choi WK revised the final manuscript; all authors -read and approved the final manuscript.
Informed consent statement: Written consent was obtained from the patient for publication of the study.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: All authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sun-Jung Yoon, MD, PhD, Assistant Professor, Department of Orthopedic Surgery, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Gunji-ro, Deokjin-gu, Jeonju 54907, South Korea. sunjungyoon@jbnu.ac.kr
Received: March 23, 2022
Peer-review started: March 23, 2022
First decision: May 30, 2022
Revised: July 11, 2022
Accepted: August 1, 2022
Article in press: August 1, 2022
Published online: September 6, 2022
Abstract
BACKGROUND

A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy. A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor. We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon.

CASE SUMMARY

A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting. The pain began 3 years ago and worsened, while the numbness in the left lower extremity lasted 1 mo. She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago. Magnetic resonance imaging revealed a suspected paralabral cyst (5 cm × 5 cm × 4.6 cm) in the left hip joint, extending to the pelvic cavity through the greater sciatic notch. The CA-125 and CA19-9 tumor marker levels were within normal limits. However, the cyst was compressing the sciatic nerve. Accordingly, endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously. A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid, stretching deep into the hip joint. An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity.

CONCLUSION

Intra- or extra- sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity. This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.

Keywords: Paralabral cyst, Ganglion cyst, Intrapelvic sciatic nerve compression syndrome, Deep gluteal syndrome, Hip joint, Laparoscopy, Case report

Core Tip: A huge juxta-articular ganglionic cyst originating from the hip joint, passing through the sciatic notch, and growing in the intrapelvic cavity is likely to exhibit sciatic nerve compression symptoms. The authors report a case in which laparoscopy and arthroscopy were performed simultaneously to treat the ganglionic cyst.