This is a VERY SHORT article published in 1951 about painful lipomas (or back mice) in 3 women that got better after surgical removal. The author, Dr. Rouhier, was a French surgeon who, not knowing previous publications about this entity, found it worthy to publish these cases.
The author presents 3 CASE REPORTS about sciatic pain related to lipomas that resolved by surgical removal of banal lipomas. The article does not show any picture. And it does not go deep on the surgical technique or the pathological findings. The author seems to be intrigued about this entity and states that he has not seen similar reports previously.
Notes on the article:
Les lipomes douloureux de l’échancrure sciatique det de la région para-sacrrée
[The Painful Lipomas of the Sciatic Notch and of the Para-sacral Region]
By M. G. Rouhier
Published on 2 May 1951
Dr. Rouhier’s FIRST CASE about painful lipomas
The author presents what he calls a “quite ordinary, fat-like, gourd-shaped lipoma”, which was removed on September 23, 1950 from a 38-year-old woman, to whom it was causing incapacitating unilateral left sciatic pain.
He is intrigued and says “In principle there are no tumors more benign, more painless and better tolerated than lipomas, as long as they do not become troublesome or disfavourous by their volume. However, in some areas where the development of lipoma is constricted by aponeurosis and where it is in contact with nerve trunks, it can become the cause of painful syndromes”
The patient who had this one was a vigorous and healthy woman, although a little obese. She led a tiring life, she sold in the markets. Her suffered sciatica, for which she came to consult Dr. Rouhier, and stopped her completely from her profession.
On examination, he found a rounded tumor on the upper and inner part of the buttock in the paracral region, of lipogenic consistency, which seemed to plunge into the depth. This tumor was not painful with light palpation, but when one pressed it strongly enough as if one wanted to reduce it, one caused a painful sensation in lightning on the path of the sciatica.
He removed the lipoma, and there was nothing abnormal macroscopically, it presented a superficial lobe having dissociated the gluteus maximus insertions and a deep lobe in the region of the sciatic notch. After debridement of a fibrous ring, he easily removed the deep lobe.
The sciatic pain disappeared immediately and the young woman was able to resume her professional occupations, now without any embarrassment.
He asked Dr. Civatte, head of laboratory at St. Louis Hospital, to examine the lipoma to find out if in its texture there was a circumstance capable of explaining this irritation or this compression of the sciatic nerve by a tumor which is ordinarily so little aggressive, that is, if it was not a fibro-lipoma but a liposarcoma. But it happened to be a common lipoma.
Dr. Rouhier’s SECOND CASE of painful lipomas
Many years ago, at the “Boucicaut Hospital”, he had operated on a para-sacral lipoma for unilateral sciatica, with complete success, a patient similar to the previous one.
Dr. Rouhier’s THIRD CASE of painful lipomas
His third observation was a more complex one. It was a woman from Belleville, whom he had operated in his department of Necker Hospital, for a complication from congenital luxation of the hip. As the result of his surgery, the patient was no longer suffering and had resumed her normal life.
About two years later, she came back to see him in the hospital, Beaujon, because she was suffering again, unable to walk again, and complaining of increasing sciatic pain. Very annoyed, he believed in some disorder inside her hip and the failure of his intervention. However, her articulation was free, her movements sufficiently wide and not painful. They performed an X-ray without any findings. Apparently, there was no reason for the pain.
But during the patient’s examination, she drew the attention from him to some lipomas around the sciatic notch on the para-sacral line, at the level of the insertion of the gluteus maximus, rounded lipomas, rather hard, painful to the pressure.
He decided to remove these lipomas to begin with, and with the lipomas gone, there was no more pain and the patient left the hospital completely healed.
He DID NOT SEE previous reported cases anywhere. However, it seemed to him that these deserved to be known.
Rouhier, G. [Painful Lipoma of the Sciatic Notch and of the Para-sacral Region]. Memoires Academie de chirurgie (France). 1951. 77 (14-15) ISSN/ISBN: 0368-829, PubMed PMID: 14852593.