Description

A 26-year-old male patient presented with a history of occasional vague lower abdominal pain since childhood. He was diagnosed with a case of functional bowel disorder. There was no history of haematuria or any loin pain. Abdominal examination revealed an ill-defined 15×12 cm lump in left part of abdomen. Ultrasonography (USG) of abdomen showed a cystic collection in lower abdomen extending up to pelvis. Contrast-enhanced CT abdomen (figure 1; lower inset) suggested a diagnosis of mesenteric cyst. On exploration, a cystic, lobulated, vascular lesion ∼15×15 cm in size (figure 1; upper inset), containing blood, fed by the left testicular artery and draining into left testicular vein, was found (figure 1; arrow). We call this entity abdominal varicocele. There was no evidence of any compression of the left renal vein between superior mesenteric artery and the aorta, thereby ruling out nutcracker phenomenon as a cause.1 ,2 A review of the CT scan also did not show any evidence of nutcracker phenomenon. Excision of the mass was performed after ligating its vascular pedicle. The right testicular vein showed tortuosity and was ligated. Histopathology suggested a lesion of vascular origin. Both the testes were normal on palpation and on USG. There was no evidence of any varicocele in the left inguinal region or scrotum, clinically or on USG. The patient has normal fertility and is doing well during follow-up. There is no report in the literature on varicocele arising from intra-abdominal testicular vasculature.3 The aetiology of this condition is speculative, probably a result of abnormality in testicular vasculature.

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Figure 1

Abdominal varicocele: operative picture. Lower inset: CT scan of the abdomen showing a cystic mass. Upper inset: the vascular mass. Arrow: testicular vessels (L).