RESUMO
The authors report the case of a 40 year old man undergoing left orchiectomy for Leydig cell tumour. Eight months later, the patient presented with a thrill in the left femoral triangle which angiography revealed to be due to a voluminous pelvic arteriovenous fistula arising at the expense of the left hypogastric artery, especially the arteries supplying the external genitalia. Surgical repair of the arteriovenous fistula was performed without prior embolisation. This haemorrhagic surgery was facilitated by the use of a blood recovery apparatus. The immediate postoperative course was uneventful and follow-up angiography one year later showed perfect stability of the result. This case offers an occasion to recall the risks of fistula during massive ligation of arteriovenous pedicles even in the case of small pedicles which should be treated with the same preventive approach as for the renal or splenic pedicle, i.e. separate ligation of the arterial and the venous element.