Robotic Precision: Easing Abdominal and Scrotal Pain After Varicocele Embolisation with Gonadal Vein Resection: A Case Report

Background: Coil associated pain is an extremely rare complication of varicocele embolisation. The lack of data relating to its incidence and pathophysiology makes devising effective management for these patients challenging. We describe a case of new-onset post-embolisation pain and its successful management with gonadal vein resection. Case presentation: A 41-year-old gentleman underwent left-varicocele embolisation for the treatment of varicocele associated pain; there were no immediate complications, and the original symptoms resolved. Two months post-embolisation the patient re-presented with new-onset pain which differed in distribution, character and intensity; the new pain localised to the left scrotum, abdomen and flank, was stabbing in nature, with a patient reported severity score of 7/10. The pain failed to respond to conservative treatment and significantly impacted upon daily function (patient reported impact score: 7/10). The case underwent a multidisciplinary review which concluded that the distribution of the post-embolisation pain correlated with the course of the gonadal vein; laparoscopic, robot-assisted vein resection was proposed as a potential solution. The patient was counselled and consented to the procedure. Intraoperatively, the vein and its coil were visualised and successfully resected without complications or injury to surrounding structures. Six weeks post-operatively the patient reported that his abdominal/flank pain had completely resolved and no longer impacted upon daily function. The intensity of the scrotal pain and its impact on daily function reduced by 60% and 65%, respectively. Conclusions: In the literature there is only one other case which describes the onset of chronic, post-embolisation abdominal pain and management with gonadal vein excision. Their findings concur with our own and so this case supports the assertion that gonadal vein resection is a safe and effective treatment that should be considered in those who fail to respond to conservative management.