A rare case of ovarian vein thrombosis presenting as acute abdomen: A case report and review of literature

Swati Francis,Shameema Anvar Sadath,Devi Krishna,Rahul Cherian

doi:10.18231/j.ijogr.2020.063

Abstract

One of the most rarest of the entities diagnosed is the ovarian vein thrombosis, especially when in the postpartum period which occurs in 0.05% -0.18% of the pregnancies mainly associated with the right side 90% of the times. The mortality and morbidity encountered has been found on a higher range if not diagnosed appropriately and at the right moment. We present forward a case of a 28-year-old woman at seven days postpartum presented with a severe excruciating right lower quadrant abdominal pain. Her contrast enhanced CT of the abdomen and pelvis revealed a large right ovarian vein thrombosis. The patient was managed as decided and planned by the involvement of a multidisciplinary team with antibiotics and anticoagulant therapy. This case we encountered illustrates the importance of prompt diagnosis and appropriate treatment of OVT therefore planning at the best interest of the patient.

Highlights

We present a postpartum case of ovarian vein thrombosis in a 28-year-old woman at seven days post normal vaginal delivery who presented with severe acute right lower quadrant abdominal pain. She was further evaluated by contrast enhanced computed tomography (CT) of the abdomen and pelvis that revealed a large right sided ovarian vein thrombosis
The patient was managed after discussion with a multidisciplinary team and with decision to work with oral anticoagulants and antibiotics
Diagnostic dilemma is always associated with this case scenario probably taking into consideration the rarity of this condition.Any delay in the diagnosis of this condition can often prove fatal to the patient involving complications such as thrombus extension to the ileo-femoral vessels and inferior vena cava and embolization to pulmonary vasculature

Summary

Case Presentation

The diagnosis of Postpartum ovarian vein thrombosis is a very rare entity, which can often prove to be potentially highly fatal. We present a postpartum case of ovarian vein thrombosis in a 28-year-old woman at seven days post normal vaginal delivery who presented with severe acute right lower quadrant abdominal pain. She was further evaluated by contrast enhanced computed tomography (CT) of the abdomen and pelvis that revealed a large right sided ovarian vein thrombosis. The latter revealed a thrombosed right ovarian vein with a minimal fat tissue stranding The case of this patient was put forward for a multidisciplinary team approach and a joint decision for conservative management with anticoagulants and antibiotics approach was made into effect. Fig. 1: ’Post contrast CT coronal a): Sagittal; b): Reformatted images showing a dilated right ovarian vein with contrast filling defect (white arrows) consistent with acute ovarian vein thrombosis’

Discussion

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Conclusion

Conflict of Interest