2675 Ovarian Vein Thrombosis as Cause of Acute Pelvic Pain After Total Laparoscopic Hysterectomy

Abstract

Study Objective Reported cases of ovarian vein thrombosis associated with laparoscopic hysterectomy for benign reasons are rare. The majority of cases described have been postpartum; other risk factors include malignancy, sepsis, and recent pelvic/abdominal surgery. We present a case of a 29 y/o G4P2 diagnosed with right ovarian vein thrombosis two weeks status post uncomplicated total laparoscopic hysterectomy (TLH), bilateral salpingectomy, and cystoscopy for chronic pelvic pain and abnormal uterine bleeding related to endometriosis. Design Case report/literature review. Setting Academic affiliated gynecology specialty clinic. Patients or Participants 29 y/o G4P2022 half pack per day smoker with chronic pelvic pain previously treated with levonorgestrel containing IUD, depo medroxyprogesterone, and continuous OCPs without symptom resolution. She previously underwent diagnostic laparoscopies with fulguration and excision of endometriosis, as well as a robotic assisted presacral neurectomy. She underwent an uncomplicated TLH/bilateral salpingectomy/cystoscopy. She presented two weeks post-op with severe right sided pelvic pain and fever. A right ovarian vein thrombosis was discovered on CT scan. Interventions Patient was admitted for antibiotics and therapeutic anticoagulation with enoxaparin, then discharged home at forty-eight hours. Two weeks later she was readmitted for continued vaginal bleeding. Anticoagulation was discontinued and patient was discharged home. Due to continued severe RLQ pain, interventional radiology was contacted for possible thrombectomy but were unable to do so. The patient then underwent a laparoscopic right oophorectomy and right ovarian vein thrombectomy seven weeks after her initial TLH. Measurements and Main Results Right ovarian vein thrombus visualized and dissected out on laparoscopy with resolution of acute localized pelvic pain. Conclusion While multiple etiologies for pelvic pain and fever after TLH exist, it is important not to overlook gonadal vein thrombosis. We recommend pre-/post-operative anticoagulation in patients with high thrombotic risk undergoing any major procedure. This case illustrates a rare diagnosis of ovarian vein thrombosis in a non-pregnant patient after minimally invasive surgery.