Introduction. The Tauber procedure, i.e. antegrade sclerotherapy for varicocele, can be complicated by ischemic colitis. Its possible pathogenesis is referred to the presence of an atypical kind of portal-systemic communication, which could represent an unfrequently reported anatomic variant. Aim of this study is to solve this anatomical controversy of utmost clinical usefulness. Materials and methods. A computer-aided and hand-checked systematic review of the literature was implemented to identify relevant publications on the topic. Moreover, we reviewed the computed tomography CT-scan of a clinical case with medico-legal implications due to severe vascular complication following Tauber’s procedure. Results. Despite specific References were made on the issue in more dated hardbacks since the 19th century, only a few clinical cases reporting an ischemic colitis following the Tauber’s procedure were found in contemporary literature. By reviewing the CT-scan images of a filed lawsuit we found traces suggestive for the presence of a significant communication between the internal spermatic and the left colic vein, as part of the portal-systemic anastomoses. Conclusions. A significant anatomical finding identified in the past have been under-reported and subsequently underestimated in its clinical value. For the first time we demonstrated its pathophysiological role in a real clinical scenario, coupling the anatomical variation to the clinical complication hence stressing that its knowledge is of utmost importance to raise the scientific awareness and to prevent possible devastating complication in clinical daily practice. Progress in the medical field coupled with increased medical-legal awareness has supported the ripening of clinical anatomy and forensic clinical anatomy, whose multidisciplinary represents the best way to recover and hand down the medical knowledge at risk of being forgotten.