Pain in the left iliac fossa: thrombosis of the spermatic vein
Acute thromboflebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a differential diagnosis in acute testicular pain. Various causes have been associated, among which terminal ileitis stands out. However, in most cases a especific etiological factor is not identified, being considered spontaneous or idiopatthic.
Eco-doppler is the most specific and sensible technique for diagnosis of theses cases, while TC can confirm etiologic diagnosis. Hematological study is necessary in order to determine coagulation alterations.
We present the case of a 49 year old man with morbid obesity who went to the Emergency department for abdominal pain located in the irradiated left iliaca fossa irradiated in the left inguinal region.
After the examination of the abdomen and with the suspicion of acute diverticulitis, an abdominal ultrasound is performed in wich a discrete parietal thickening of the sigma is observed, suggestive of an inflammatory process,
An abdominal scanner is request, and signs compatible with acute diverticulitis an image of thrombosis of left gonadal efferent vessels are not observed.
The treatment of thrombosis of the spermatic vein is controversial, if the diagnosis is clear, anticoagulant therapy is initiated, if the appearance in the imaging tests is not clear it will be treated with anti-inflammatory, testicular suspensory and reletive rest.
