The patient was operated on of a disc lesion three years before with the same complaints, and after the operation the pain still persisted. PRESENT 2 casesĬase 1– A 50-year-old woman complaining of left leg pain. Singewald said that these nodules are present in 16% of the population and that only 10% of these individuals are symptomatic. – Episakral lipoma is common in the general population and is often asymptomatic. They are subfascial fatty tissue that has become a hernia through thoracodorsal fascia. In clinical practice, these nodules, called the Copeman nodules, are one of the major causes of acute and chronic low back pain. Copeman and Ackerman used the term lumbar fascial fat herniation to give a definitive anatomical explanation to these nodules for the first time in 1944. The original description of these nodules as episacroiliac lipomas was first made by Ries in 1937. – Episakral lipoma is a deeply subcutaneous, rubber-like fat nodule, often mobile, round or oval in shape, localized in the lumbosacral region. These episakral lipomas have also been reported to lead to different referral pain patterns such as major trochanteric pain syndrome (BTE) and abdominal pain, which cause confusion in the diagnosis. The pain persists after this unnecessary surgery. It has been reported that this disease can produce severe pain -similar to discopathy- and that, therefore, unnecessary disc surgery can be performed erroneously. In studies to understand the pathophysiological mechanisms leading to low back pain, little attention has been paid to the connective tissue forming the facial surface of the back, and pathologies such as fat nodulation and herniation in the thoracodorsal fascia have remained only in sporadic case presentations. Various studies have shown that episakral lipomas are one of the important causes of acute and chronic low back pain. Episakral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain. In both patients, symptoms appeared to be relieved by local injection of anesthetic and steroid. The other patient had been treated for greater trochanteric pain syndrome. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent unsatisfactory disc operation. Here we describe 2 patients with painful nodules over the posterior iliac crest. Local injection of the nodule with a solution of anesthetic and steroid is effective in treating the episakral lipoma. Medication and physical therapy may not be effective. The presence of a painful nodule with disappearance of pain after injection with anesthetic, is diagnostic. This clinical entity is common, and recognition is simple. Episakral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. Episakral lipoma is a significant and treatable cause of acute and chronic low back pain. PubMed PMID: 23720083. FREE online article ORIGINAL abstract from the article by Erdem et al.Įpisakral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Erdem, H.R., Nacır, B., Özeri Z., Karagöz, A.Īgri. Episakral lipoma: Bel ağrısının tedavi edilebilir bir nedeni.
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