Case report of a successful multidisciplinary approach to a
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Congenital pelvic malformations are rare and represent a difficult therapeutic challenge. Scrotal arteriovenous malformations are quite unusual, with only a few such cases reported in the literature. Only one case of scrotal malformation due to an arteriovenous fistula resulting in azoospermia has been described.

A male patient (42 years old) who presented with a scrotal tumefaction. This tumefaction was approximately 15 x 17 cm in size and had been progressively developing after surgery for the removal of a left-side testicular angioma. Secondary sterility had occurred, as suggested by a spermiogram that revealed azoospermia (<20000 spermatozoa/ml). Ultrasonographic test results performed during hospitalization revealed a diagnosis of scrotal arteriovenous malformation. The exam results indicated the presence of a raw agglomerate of enlarged blood vessels located in the left-1 side scrotal portion that was causing a contralateral dislocation of the right testicle

The patient, underwent a selective catheterization of the arterial ramifications via a left-side percutaneous transfemoral approach originating from the left femoral and left hypogastric arteries. A postprocedural angiographic check indicated the devascularization of the lesion and a slight reduction in the size of the scrotal tumefaction. Two days after the procedure, a second embolization was performed via a left transfemoral approach to obtain a further reduction in the vascularization of the tumefaction, combined with the selective catheterization of the arterial ramifications coming from the right femoral and right hypogastric arteries (Fig. 2). After 72 hours from the embolization skin necrosis on the hemiscrotum due to ischemia of the area previously supplied by the anomalous blood vessel was present. To avoid the development of a serious form of infected necrosis, such as Fournier’s gangrene, the patient underwent repeat surgery and debridement of the wide necrotic skin tissue (Fig. 3A B).

During the following days, the patient received daily medications at the lesion site, coupled with endovenous antibiotic therapy. The agglomerate progressively decreased in size, and the necrotic area increased its demarcation. The patient was discharged from the hospital with antibiotic therapy 20 days after the first embolization procedure. In addition, he was prescribed daily medications, and he underwent subsequent plastic surgery for scrotal reconstruction. The spermiogram result showed azoospermia in both testicles.