Superior gluteal vein syndrome: an intrapelvic cause of sciatica.

The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict-the SGV syndrome-should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology.

Coexistence of gastrointestinal stromal tumour and colorectal adenocarcinoma: Two case reports.

TThis paper reports two rare cases of patients with synchronous gastrointestinal stromal tumour (GIST) and colorectal adenocarcinoma (CRC) where adjuvant FOLFOX chemotherapy was administered concurrently with imatinib mesylate. The first case is a 67-year-old woman with a large gastrointestinal stromal tumour with metastasis masking a co-existing primary colon cancer, which was diagnosed after tumour response to imatinib mesylate. The second case presents a 61-year-old male with a primary colon cancer and a suspected metastatic lymph node, later confirmed to be a co-existing primary gastric GIST during colon surgery. While colorectal cancer is the third most common cause of cancer-related death in North America, the prevalence of GISTs remains rare. To date, very few cases of synchronous GIST and CRC adenocarcinoma have been reported in the literature. Although the coexistence of these two tumour types is rare, it is important to be aware of their disease patterns.