Abstract
A 61-year-old male was admitted to our hospital with left buttock pain and fever of more than 39 degree. He had been treated with an acupuncture treatment for lumbago 3 days before. He also suffered from gait disturbance and numbness of the left leg on admission. Magnetic resonance imaging showed an aneurysm with abscess formation in the left gluteal region. Computed tomographic scanning documented that the left internal iliac artery was large and tortuous, forming an aneurysm about 3 cm in diameter at his left hip region, and ran to the left popliteal artery. These findings established the diagnosis of persistent sciatic artery (PSA) aneurysm with infection. He was treated surgically next day on admission. At first, on the supine position, the left internal iliac artery was exposed retroperitoneally by para-rectal skin incision. The left popliteal artery was also exposed by small skin incision above the left knee. Both the arteries were cut off at the pelvis and the adductor magnus, respectively. The aneurysmal side of these arteries were closed. A vascular prosthesis (8 mm ringed expanded polytetrafluoroetylene graft) was interposed between these arteries. The graft was passed beneath the inguinal ligament along with the hypoplastic external iliac and femoral artery to avoid the contamination from the infectious aneurysm. Finally, the infectious PSA aneurysm was excised on the right lateral position. The sciatic neuralgia and fever disappeared immediately after the operation. Methicilline-sensitive staphylococcus aureus was detected both from the preoperative blood sample and intraoperative purulent discharge around the aneurysm. He was discharged on postoperative day 19 with no recurrence of infection.
