Publish in OALib Journal
APC: Only $99
Purpose: Haemangiomas and vascular
malformations are not easy to differentiate clinically. We describe a patient who was initially thought to have a scrotal venous
malformation (VM) but after pathological
examination was diagnosed to be afflicted with an arteriovenous malformation (AVM) with a micro-fistula in pathorogical photo. We think that even if
there are suspicions of VM before the operation, the importance of resection
with an ample margin of safety is indicated. Material and Method: A 38-year-old man who noticed a mass in his scrotum. The patient was seen
at our hospital in May 2009 with concern for progression of the scrotal mass.
That mass appeared to indicate a simple case of VM of the scrotum. Result and Conclusion: A biopsy of the mass was performed and
was diagnosed to be a micro-fistula AVM, with no tumour growth in the vascular
endothelial cells. Resection was performed in September 2009. And there is no
recurrence. Even if there are suspicions of VM before the operation, the
importance of resection with an ample margin of safety is indicated.
The presence of both uterine and
arteriovenous malformation in a patient is rare. For these patients a cesarean
section can be life threatening due to uncontrolled massive hemorrhage.
Prevention and control of massive blood loss utilizing a multidisciplinary
approach can be lifesaving. We present a case report of a 33 years old pregnant woman at 35 weeks of
gestation diagnosed with an extensive uterine arteriovenous malformation and
innumerable tortuous vessels who was scheduled for a cesarean section. Her
previous vaginal delivery was complicated by significant bleeding requiring uterine artery embolization. Pre-operative
prophylactic aortic and right iliac artery balloon occlusion catheters were
placed under monitored anesthesia care. The extracorporeal life
support team was
available to initiate veno-venous or arteriovenous bypass. Cesarean section was
performed with careful identification of the uterine vessels under ultrasound
guidance and ultimately the bleeding was well controlled. Postoperatively, the
patient underwent uterine artery embolization. It is our strong belief that
although we did not face a major disaster during this cesarean section, our
comprehensive plan and
multi-disciplinary approach were essential to ensuring the safety of the
parturient and newborn.