Ischemic colitis following left antegrade sclerotherapy for idiopathic varicocele.
Clin Anat. 2018 Sep;31(6):774-781. doi: 10.1002/ca.23066. Epub 2018 Mar 24.
Boscolo-Berto R, Macchi V, Porzionato A, Morra A, Vezzaro R, Loukas M, Tubbs RS, De Caro R.
Abstract
The Tauber procedure, i.e., antegrade sclerotherapy for varicocele, can lead to ischemic colitis. The pathogenesis can involve an atypical systemic-portal communication, which could represent an infrequently reported (rare) anatomical variant. The aim of this study is to review clinical cases from the literature to highlight the anatomical bases of such complications. A computer-aided and hand-checked review of the literature was used to identify relevant publications. Also, the computed tomography (CT) examination of a clinical case with medico-legal implications due to severe vascular complication following Tauber's procedure was reviewed. Although specific references to this complication have appeared since the 19th century, reports in the contemporary literature include only a few clinical cases of ischemic colitis following Tauber's procedure. The CT scan images of a filed lawsuit revealed traces suggesting a significant communication between the testicular and left colic veins, forming part of the systemic-portal anastomoses. An anatomical variation consisting of a communication between the testicular and left colic veins has been described from the clinical point of view, corresponding to a significant anatomical finding identified in the past that has been under-reported and its clinical importance subsequently underestimated. For the first time we have demonstrated its pathophysiological significance in a real clinical scenario, linking the anatomical variation to the clinical complication. This demonstrates the importance of raising scientific awareness on this issue to prevent possibly devastating complications in daily clinical practice. Clin. Anat. 31:774-781, 2018.
© 2018 Wiley Periodicals, Inc.
KEYWORDS:
Tauber's procedure; anatomical variation; antegrade sclerotherapy; clinical anatomy; complication; ischemic colitis; legal medicine