Posttraumatic Rupture of Varicose Testicular Vein in Adolescent: Case Study

Background. Venous malformations development is explained by primary venous systems preservation forming inferior vena cava during the embryonic period. Its anomalies lead to thin-walled phlebectatic transformation of gonadal veins; their injury can lead to rupture and continuing bleeding. Such conditions threaten patients’ lives in case of previously undiagnosed vascular system malformations.
Case description. 13 years old boy was delivered to emergency department by ambulance with complaints of severe pain in the left half of abdomen and general weakness. Historical data: the child was hit in the stomach during training one hour before admission. The patient's general condition was critical. There were signs of ongoing internal bleeding according to ultrasound examination of abdominal cavity and pelvis, arterial blood pressure fall, and low hemoglobin concentration. Urgent midline laparotomy was performed: large retroperitoneal hematoma was visualized from the iliac vessels going up along the spine. Thin-walled lesion with partial rupture on its lateral wall was revealed during retroperitoneal space revision after evacuation of hematoma. The child was consulted by specialists of the federal center for pediatric vascular surgery after the intervention, he subsequently underwent reconstructive surgery on retroperitoneal space vessels on the left. Tributaries of aneurysmal left testicular vein functioning as inferior vena cava were crossed, varicose left gonadal vein was removed. The child was discharged on the 10th day after the surgery.
Conclusion. Congenital vascular abnormalities combined with aneurysmal transformations are extremely rare variant of vascular system malformations in children. Often such anomalies are revealed sporadically. In our opinion, aggressive surgical tactic with removal of varicose sites is effective in case of such transformations as it prevents any rupture and thrombosis.

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