Abstract
BackgroundOvarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.Case presentationA 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.DiscussionPathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT.ConclusionsOVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.
Highlights
Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women
Anticoagulation and antibiotics is the mainstay of treatment of OVT
A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen
Summary
The first case of postpartum ovarian vein thrombosis was described by Austin in 1956 [2]. In 8090% of the cases the right ovarian vein is the one affected, commonly 2-15 days following delivery. Increases the risk of thrombosis to 1-2% and multiparity has been identified as a risk factor for thrombosis in general [3,4] Rare causes of this entity are pelvic inflammatory disease, malignancies, Crohn’s disease and pelvic surgical procedures [5,6]. The morbidity of OVT arises from complcations such as sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. If the patient fails to respond to standard medical treatment or severe complications occur, options range from placement of an IVC Greenfield filter to hysterectomy and thrombectomy or even ligation of the inferior vena cava [11]. There are no recommendations for prophylaxis during a subsequent pregnancy, unless a hypercoagulable state is proved
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