Spontaneous spermatic vein thrombosis as a circumstance of discovery of the nutcracker syndrome: An exceptional entity

Mallat, F.; Hmida, Wissem; Ahmed, Khaled Ben; Mestiri, S; Mosbah, Faouzi

doi:10.5348/ijcri-201492-cr-10403

Cited by 12 publications

(8 citation statements)

References 11 publications

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“…Another controversial issue is whether to perform just ligation of the vein or to completely excise the segment of the thrombosed vein? Mallat et al also reported a case where they had done complete excision of the thrombosed vein [ 10 ]. We also did surgical excision of the thrombosed vein as we felt that doing a simple ligation may not alleviate the pain completely.…”

Section: Discussionmentioning

confidence: 99%

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

2018

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BackgroundAcute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage it conservatively in all patients by drugs and scrotal support with little description of the surgical treatment. Herein, we present an unusual sixth case of spontaneous thromboses of varicocele and discuss its presentation and surgical management. We would also like to highlight the differentiating points between spontaneous thrombosis and post operative in vitro clot formation in the varicoceles, as these two entities can often be confused for each other.Case presentationA 68 year-old man presented with excruciating scrotal pain of one week duration. Doppler study of scrotum revealed left varicocele with no evidence of Epididymo-orchitis. He was treated with intravenous antibiotics, analgesics and scrotal elevation. He had no relief and continued to have severe pain. Clinical examination was normal. Patient underwent exploratory surgery on a semi- emergent basis. Exploration revealed normal testis with thrombosed varicoceles. Patient underwent Varicocelectomy. Postoperatively patient had immediate pain relief. Histopathology revealed prominent thrombosed varicocele. A varicocelectomy specimen (done for primary infertility) was used for comparison. The differentiating points between the two entities were noted.ConclusionSpontaneous thrombosis of varicocele is a rare cause of acute scrotal pain. Pain out of proportion to clinical features is characteristic. Patients not responding to medical therapy may need varicocelectomy. Varicocelectomy may give immediate relief. Histopathology is useful in this disorder.

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Section: Discussionmentioning

confidence: 99%

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

2018

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“…Conservative management, including watchful observation and NSAID without anticoagulation, is acceptable for thrombosis out of external inguinal ring (pampiniform plexus). Yoko Kyono et al proposed surgical excision, and anticoagulation may prevent pulmonary embolism in deep-seated spermatic vein thrombus inside the external inguinal ring and extending to the nearby renal vein [25]. Though the management remains unclear, proximal extension of the thrombosis is the most significant indication for further investigation.…”

Section: Discussionmentioning

confidence: 99%

Bilateral spontaneous thrombosis of the pampiniform plexus mimicking incarcerated inguinal hernia: case report of a rare condition and literature review

Bakshi

2020

surg case rep

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Background: Pampiniform plexus thrombosis is a very rare disease (only less than 25 published cases are available till date), and it is a diagnostic dilemma. The present case is an unusual condition of an elderly gentleman who was finally diagnosed as a case of spontaneous thrombosis of bilateral pampiniform plexus and was managed conservatively. Literature was reviewed to explore potential etiologies and therapeutic strategies. Case presentation: A 65-year-old afebrile gentleman, laborer (in brick industry), and non-smoker with no previous major health problems was admitted with swelling in the bilateral inguinal region. The swelling had started one and half months ago. He had developed severe pain over the swelling for last 1 day with tenderness and indurations. Neither he had history of previous surgeries, chronic cough, dysuria, prostatism, and trauma nor he presented any thrombogenic factors. There was no history of vomiting, abdominal pain, and obstipation. Physical examination revealed normotensive person with BMI of 22.5, was significant only for one tender, movable, and firm to hard 10 cm × 3 cm mass extending from the left deep inguinal ring up to the upper pole of the testis in the scrotum. Another 5 cm × 3 cm mass of similar characteristics was found extending from deep inguinal ring up to the root of the scrotum on right side. The testes and prostate were normal on palpation. On the contrary to preoperative USG, which clinched suspicion of incarcerated inguinal hernia, a thrombosed pampiniform plexus without any evidence of hernia sac was found on the left side during inguino-scrotal exploration. Wound was closed without doing any further procedure. Contralateral inguino-scrotal exploration was spared considering same nature of disease. Postoperative Doppler ultrasonography confirmed the diagnosis of bilateral thrombosed pampiniform plexus. MDCT of whole abdomen revealed no abnormality other than bilateral spermatic cord thrombosis. Blood thrombophilia screening came normal. The subject had an uneventful postoperative hospital course. With 2 years of follow-up, the gentleman is doing well, remaining asymptomatic and had returned to his usual life. Conclusions: Due to extreme rarity, spontaneous thrombosis of the pampiniform plexus may be a diagnostic dilemma and requires a high index of suspicion. Doppler ultrasound is the initial investigation of choice. In the absence of other concomitant disease, beginning the treatment conservatively instead of excising the thrombosed segment is more suitable.

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“…The literature has described several etiologies for spermatic vein thrombosis, which include protein C deficiency, factor V Leiden mutation, underlying cancer, cardiac catheterization complications, inguinal region injury, and after suspected coronavirus disease 2019 (COVID-19) infection [1][2][3][4][5][6][7]. The nutcracker syndrome where there is compression of the left renal vein in the aortomesenteric space is also complicated by spermatic vein thrombosis in one study [8]. Retroperitoneal masses can cause venous blood flow obstruction and thrombosis, but the CT scan of our patient was normal.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bilateral Spermatic Vein Thrombosis: A Rare Clinical Presentation

Kolleri¹,

Abdirahman²,

Mahmood³

et al. 2021

Cureus

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Cases of acute scrotum presenting to the emergency department are usually due to testicular torsion, complicated hernia, or epididymo-orchitis. Thrombosis of the spermatic vein is an uncommon entity and most of the cases reported to date are of unilateral involvement. Here, we present an extremely rare case of spontaneous bilateral spermatic vein thrombosis, which was diagnosed by a Doppler ultrasound of the testes. This article highlights its clinical presentation, radiological imaging, etiology, and management.

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Spontaneous spermatic vein thrombosis as a circumstance of discovery of the nutcracker syndrome: An exceptional entity

Cited by 12 publications

References 11 publications

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

Bilateral spontaneous thrombosis of the pampiniform plexus mimicking incarcerated inguinal hernia: case report of a rare condition and literature review

Spontaneous Bilateral Spermatic Vein Thrombosis: A Rare Clinical Presentation

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