We report the case of a 25-year-old man with no relevant personal history.
Nocturnal erections increase due to blushing penis blunt trauma caused by direct blow against the corner of a door, appearing 48 hours after unpainful, incomplete sexual erection.
The examination showed a normal penis, in incomplete erection, painless to palpation.
No signs of trauma were observed (absence of wounds, bruising,...).
Tests and scrotum are normal.
Blood gas analysis was performed by puncture of the vesicular body with arterial blood type, with a pO2 of 97 mmHg and oxygen saturation of 98%.
High diagnostic suspicion of arterial priapism, a color Doppler ultrasound was performed showing an intense arterial flow in the root of both vesicular bodies.
An image of a right coronary artery pseudoaneurysm disappears after compression with the ultrasound transducer.
After these findings, an arteriography was performed.
The contralateral iliac artery was catheterized through the left femoral access, leaving the distal end of a curved 6 Fr., immediately above the hypogastric artery.
The artery was selectively catheterized using a 6 Fr multipurpose angiographic catheter. An angiographic study showed the existence of a right arteriovenous fistula.
Through this catheter, a 3F microcatheter was coaxially placed, extending towards the right arteriovenous fistula.
Subsequently, selective embolization of the right fistula with resorbable material consisting of Gelfoam particles was performed.
After embolization of the right coronary artery fistula, the patient developed priapism.
Color Doppler ultrasound was performed to check for persistent fistula.
Later, arteriography demonstrated the existence of fistula in the contralateral side, which was embolized in a second time, one week after the first embolization.
Right femoral approach was performed, progressing through the left hypogastric fistula to objectify, which was also embolized with absorbable particles.
There was a detumescence of the erection, approximately at 24 hours of evolution and, by means of a new angiographic image, bilateral occlusion of both fistulas was verified.
The patient was successfully treated with 50 mg sildedafil citrate and recovered physiological erection.
Currently, the patient achieves and achieves good quality without pharmacological help.
