A case of bleeding scrotum arteriovenous malformations
Wei-Hsun Hsu1,2, Ti-Yuan Yang1,2
1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
2Department of Medicine, Mackay Medical College, Taipei, Taiwan
Scrotum arteriovenous malformation (AVM) is one of the scrotum vascular diseases. The etiology may be congenital or post-traumatic. We present a rare case of congenital huge scrotum AVM with bleeding who got intervention therapy for treatment.
A 18-year-old man presented with left scrotal swelling with easily bleeding for 1 day. He had a past history of congenital scrotum AVM with spontaneous bleeding and underwent transarterial embolization (TAE) for three times at other hospital 6 years ago. Owing to continuous scrotum bleeding since yesterday, he visited our emergency department. On physical examination, we found subcutaneous engorged vessel on the surface of whole scrotum, scrotum enlargement sized 13*12*9cm and one 0.5 cm wound with easily bleeding on the left side of scrotum. Laboratory examination was within normal limit. Vascular imaging of CT scan with and without contrast showed a huge arteriovenous malformations at left scrotum, feeding from bilateral superficial femoral arteries, left deep femoral artery and pudendal artery. Conventional methods of hemostasis including direct pressure and hemostatic agents such as epinephrine were attempted at emergency department. Persistent bleeding on the wound was still found after the above methods. We performed TAE with Lipiodol the next day by radiologist. After the intervention, less bleeding on the wound of scrotum and pain improvement were noted. The patient was discharged six days after TAE.
To our knowledge, scrotum AVM is a rare disease in scrotum vascular disease that presented with engorged vessel or scrotum enlargement. Patients often seek help for medical units due to bleeding or ulceration. CT angiogram can make an accurate diagnosis of AVM or other vascular disease. We can start conservative treatment initially. If still poor treatment after conservative methods, further intervention therapy or surgery may be considered.