Methods: This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. Objective: To highlight the need to examine the course of the sciatic nerve for local pathology when the cause of sciatica is not obvious.

Background: Sciatic herniae are rare. The coexistence of sciatica and a gluteal abscess, caused by a strangulated sciatic hernia, does not appear to have been reported previously.

Methods: A 66-year-old woman with preexisting low back pain and left leg pain was admitted to the hospital with intestinal obstruction and a left gluteal mass. Results of needle aspiration suggested the diagnosis, which was confirmed by laparotomy. The sciatic hernia was repaired via a transabdominal approach.

Results: The symptoms of sciatic nerve compression and intestinal obstruction resolved fully after surgery.

Conclusions: The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.