Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 57, Num. 4, 2011, pp. 339-340

Journal of Postgraduate Medicine, Vol. 57, No. 4, October-December, 2011, pp. 339-340

Case Snippet

A diagnostic dilemma: Arteriovenous malformation of spermatic cord presenting as irreducible inguinal swelling

MA Joshi¹, M Gadhire¹, A Dhake¹, M Patil²

¹ Department of General Surgery, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
² Department of Pathology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
Correspondence Address: M Gadhire, Department of General Surgery, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India, gadhireminakshi@yahoo.in

Code Number: jp11094
PMID: 22120867
DOI: 10.4103/0022-3859.90090

Arteriovenous malformation (AVM) in the spermatic cord is a rare condition. We are presenting a case of right inguinal irreducible swelling diagnosed clinically as an irreducible inguinal hernia but intraoperatively found to be an inflammatory mass. On histopathologic evaluation, the mass was diagnosed to be an AVM.

A 25-year-old male patient presented in the emergency with painful, irreducible swelling in the right inguinal region since 3 days. The patient had history of vomiting, but no distension of abdomen, constipation or obstipation. There was no history of fever. On clinical examination, the patient had an irreducible swelling in the right inguinal region. The swelling was tender with warmth and redness over the overlying skin. The cough impulse was negative. On per-abdominal examination, there was no tenderness or guarding over the abdomen. There was no hyperperistalsis. X-ray abdomen showed no significant findings. Due to the presence of acute irreducible inguinal swelling with a clinical suspicion of irreducible hernia, decision was taken to explore the patient. On exploration of the right inguinal region, there was a firm mass of spermatic cord, which was edematous and inflamed. There was no hernial sac. So, the decision was taken to excise the mass. The mass was separate from the vas and testicular artery and we were able to preserve the vas along with artery and few veins. Postoperatively, the patient was stable and was discharged on day 3. The histopathology report was suggestive of AVM [Figure - 1].

AVM is an abnormal connection between veins and arteries. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. AVMs involving the spermatic cord are uncommon as opposed to AVMs located in the Central Nervous System. AVMs of the spermatic cord are benign lesions consisting of complex tangles of enlarged dilated arteries and veins without the intervening capillaries. Spermatic cord AVM has been reported for recurrent testicular pain. ^[1] Spermatic cord AVMs presenting as paratesticular swelling or incidental findings in a patient of infertility have also been reported. ^[2],[3] To our knowledge, spermatic cord AVM presenting as irreducible tender swelling in the inguinal region has not been reported in the literature.

In our case, the patient had presented in the emergency with acute symptoms suggestive of irreducible inguinal hernia, so emergency exploration was carried out. But the diagnosis of AVM of spermatic cord was made only on the basis of histopathology report. So, from this experience, we should keep in mind that AVM of spermatic cord can be one of the differential diagnoses of irreducible inguinal swellings.

References

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