Septic Pelvic Thrombophlebitis Research Articles

Extensive septic pelvic thrombophlebitis in a puerperal woman: a case report

OBJECTIVE: This article aims to report an extensive case of septic pelvic thrombophlebitis, a rare, severe, and challenging diagnostic condition. The clinical picture may range from mild to severe sepsis. Its diagnosis is of exclusion, but it can be complemented with imaging exams. CASE DESCRIPTION: We report a case of postpartum thrombophlebitis in the infrarenal portion of the inferior vena cava, external and internal common iliac veins, bilateral common femoral veins, as well as in the right ovarian vein, presenting with persistent fever and negative cultures. The patient showed significant clinical improvement after association of anticoagulation and antibiotic therapy. CONCLUSION: Septic pelvic thrombophlebitis is an important differential diagnosis for abdominal pain and fever in the postpartum period, but the absence of specific complementary tests makes its diagnosis challenging, which often leads to misdiagnosis of acute appendicitis, endometritis, pelvic inflammatory disease, pyelonephritis, nephrolithiasis, adnexal torsion, or pelvic abscess. The key to correct diagnosis is a high level of clinical suspicion, especially when there is resistance to broad-spectrum antibiotic therapy and remission after systemic anticoagulation. Given the large number of cesarean sections performed today and their correlation with septic pelvic thrombophlebitis, an increase in the number of cases should be accompanied by greater familiarity of health professionals with this complication, in order to avoid inadequate propaedeutics and conducts. In this context, the present case report documents the importance of investigating pelvic septic thrombosis in patients with fever in the puerperium and its differential diagnoses for early initiation of therapy to reduce morbidity and mortality.

PBI-009 - Septic pelvic thrombophlebitis: A “pain in the back”

PBI-009 - Septic pelvic thrombophlebitis: A “pain in the back”

Postpartum septic pelvic thrombophlebitis and ovarian vein thrombosis after caesarean section: a rare case report

BackgroundSeptic pelvic thrombophlebitis (SPT) is a well-recognized but rare puerperal complication that has two types: ovarian vein thrombophlebitis (OVT) and deep septic pelvic thrombophlebitis (DSPT). The present case report describes the clinical and imaging findings of a female patient diagnosed with right ovarian vein infectious thrombophlebitis after caesarean section (C-section).Case presentationA 35-year-old G3P2 female who presented with a foetal vein Galen malformation at 41 weeks of gestation underwent C-section. The patient had high fever after C-section, and anti-inflammatory treatment was not effective within 1 week. An abdominal wall incision haematoma was found, and a second surgery for the removal of the abdominal wall haematoma was performed. The patient was ultimately diagnosed with abdominal incision haematoma and right ovarian vein infectious thrombophlebitis after C-section. We used imipenem and tigecycline to strengthen the anti-inflammatory effects, simultaneously administrating low-molecular-weight heparin and warfarin as anticoagulant therapy. On the 30th day after C-section, the right ovarian vein thrombus disappeared.ConclusionThis case illustrates the need to consider the potential relationship between abdominal incision haematoma and ovarian vein thrombophlebitis. Despite advances in the management of venous thromboembolism globally, more data on epidemiology in terms of first incidence, prevalence, recurrence and risk factors, management of bleeding complications, and increased awareness in Asian populations are necessary.

Antimicrobial Prophylaxis for Caesarean Delivery; A comparative study between different agents

Antimicrobial prophylaxis is commonly used for pre-intra and post-operative caesarean delivery. Caesarean delivery is still the single most important risk factor for puerperal infection. Post-caesarean infections include wound infections, endomyometritis, bacteraemia, septic shock, septic pelvic vein thrombophlebitis, necrotising fasciitis, pelvic abscess, dehiscence of the wound or evisceration. The goal of antimicrobial prophylaxis is to put a stop to postoperative infection of the surgical site, the use of therapeutic antibiotics, additional surgical interventions, longer duration of hospital stay, to decrease postoperative infectious morbidity and mortality and the cost of postoperative health care. A post-caesarean wound infection detected prior to hospital discharge will lead to prolongation of hospital stay and will increase the hospitalisation costs and need of readmission. Both the American College of Obstetricians and Gynaecologists and the American Society of Health-Care System Pharmacists have introduced single-dose prophylactic protocols using a heterogeneity of agents (penicillins, cephalosporins, clindamycin and azithromycin). Women undergoing caesarean delivery have a greater risk of developing infection compared to women who have a vaginal birth by 5 to 20-fold. The use of prophylaxis in patients undergoing a low-risk Caesarean Delivery remains controversial.

Case Report: Septic Pelvic Thrombophlebitis and wide spread extensivethrombosis in the background of Anti Phospholipid Antibody Syndrome

Septic pelvic thrombophlebitis with wide spread thrombosis in the background of Anti phospholipid Antibody Syndrome has not been previously described. We aim to report such a case in a previously healthy young woman. Persistent fever with bacteremia in postpartum period along with vascular thrombosis at unusual sites was found in this patient, treatment was ensued with IV antibiotics and anticoagulation leading to full recovery.

Deep Septic Pelvic Thrombophlebitis – a Life-Threatening Condition in Postpartum Period

SUMMARYDeep septic pelvic thrombophlebitis is a rare but potentially devastating complication in the puerperium. Early diagnosis and aggressive treatment of this postpartum complication is essential. We report a case of a 23-year-old multipara, who presented with persistent high fever and abdominal pain two days after delivery. Diagnosis of deep septic pelvic thrombophlebitis was suspected and confirmed by using contrast-enhanced computerized tomography. Upon admission in the intensive care unit, she developed shortness of breath together with hypoxemia, which was attributed to septic pulmonary emboli. Streptococcus pyogenes group A was cultured from cervical swab. Treatment consisted of broad spectrum antibiotic therapy and low molecular weight heparin. She was dismissed for home care symptom-free fourteen days after delivery and referred to hematologist to diagnose the possible causes of thrombophilia.

Chorioamnionitis and Infectious Complications after Vaginal Delivery.

To estimate the incidence of and define risk factors for postpartum infectious complications after vaginal birth after cesarean (VBAC) complicated by chorioamnionitis. A secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Cesarean Registry was performed. The primary outcome was a composite of postpartum infection: endometritis, sepsis, pelvic abscess, urinary tract infection, necrotizing fasciitis, and septic pelvic thrombophlebitis. Peripartum predictors were compared using parametric and nonparametric tests, as appropriate, and multivariate predictors assessed using logistic regression. A total of 559 subjects had chorioamnionitis in labor and a successful VBAC. Twenty-four (4.3%) subjects experienced the primary outcome, mainly due to endometritis (19/24). Significant factors included preterm delivery <32 weeks (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.32-7.06) and body mass index (BMI) ≥40 (OR: 4.63, 95% CI: 1.25-17.14). Receipt of postpartum antibiotics was protective against postpartum infection (OR: 0.28, 95% CI: 0.12-0.65). In multivariate analysis, preterm delivery <32 weeks, BMI ≥40, and receipt of postpartum antibiotics remained associated with postpartum infection. Nearly 5% of women with chorioamnionitis had a postpartum infectious complication after vaginal delivery, with higher rates in those delivering at <32 weeks and with prepregnancy BMI ≥40. Receipt of postpartum antibiotics decreased the odds of postpartum infection markedly.

Septic Superficial Femoral Vein Thrombophlebitis Causing Pulmonary Emboli and Respiratory Failure: Case Report and Review of the Literature

Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.

Septic pelvic thrombophlebitis following cesarean delivery: a case report

Despite rare prevalence of septic pelvic thrombophlebitis (SPT), high mortality and morbidity in untreated or delayed diagnosed cases are expected. Thus, early diagnosis and therapeutic management of disease is very vital. The present report describes a febrile case with strong suspicion to SPT that successfully responded to anticoagulant therapeutics. The patient was initially diagnosed with severe sepsis due to cesarean section and managed by antibiotic therapy. Because of persisting fever and no response to antibiotics, and with a strong suspicion of SPT, patient was treated with anticoagulant medication. Two days after beginning anticoagulant therapy, the nature of fever significantly changed to low grade and spiking. Four days later, she was completely afebrile. Therefore, SPT may imitate some common postoperative complications and thus should be considered as a serious post-cesarean event.

Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort.

Objective The objective of this study was to identify risk factors associated with the development of septic pelvic thrombophlebitis (SPT). Study Design This is a secondary case–control study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Cesarean Registry. SPT was defined as suspected infectious thrombosis of the pelvic veins, often persistent febrile illness in the setting of antibiotic therapy for endometritis. Women with SPT were compared with those without SPT using descriptive statistics. Logistic regression models estimated the association between selected risk factors and SPT. Results Of 73,087 women in the cohort, 89 (0.1%) developed SPT. Women with SPT were more likely to be &lt; 20 years old (33.7 vs. 10.6%, p &lt; 0.001), black race (58.4 vs. 29.1%, p &lt; 0.001), and nulliparous (51.1 vs. 23.3%, p &lt; 0.001). Hypertensive disorders of pregnancy (32.6 vs. 11.8%, p &lt; 0.001) and multiple gestation (12.5 vs. 7.4%, p = 0.03) were also more common in women with SPT. In the multivariable regression model, maternal age &lt; 20, black race, multiple gestation, and preeclampsia were all significantly associated with increased odds of SPT (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.22, 3.14; aOR: 2.6, 95% CI: 1.68, 4.02; aOR: 2.10, 95% CI: 1.13, 3.88; aOR: 2.91, 95% CI: 1.86, 4.57). Conclusion SPT is a rare pregnancy complication. Our analysis confirmed known risk factors (e.g., infections, cesarean delivery), and identified novel ones, including black race, young age, preeclampsia, and multiple gestation.

342: Risk factors for developing septic pelvic thrombophlebitis in a high-risk cohort

342: Risk factors for developing septic pelvic thrombophlebitis in a high-risk cohort

Strip of the Month: Maternal Fever in Labor

Strip of the Month: Maternal Fever in Labor

Postpartum Septik Pelvik Tromboflebit, İlaç Ateşi ve Yara Yeri Enfeksiyonu

Operasyon sonrası görülen ateş ?febril morbidite? olarak tanımlanır. Febril morbidite, jinekolojik ve obstetrik operasyon sonrası sık karşılaşılan bir komplikasyondur. Ateş postoperatif enfeksiyonun ilk bulgusu olmakla birlikte, her operasyon sonrası ateş febril morbidite ve her febril morbidite de bir enfeksiyonun varlığını göstermez. Bu çalışmada, postpartum febril morbiditesi olan ve bu duruma yol açabilecek üç farklı klinik antitenin bir arada görüldüğü bir olgu sunulmuştur.

Bilateral Purtscher-Like Retinopathy With Profound Macular Ischemia and Vision Loss in Severe Pre-Eclampsia

Purtscher-like retinopathy is an extremely rare condition in patients with pre-eclampsia. The bilateral vision loss as seen in the current case is infrequent, but devastating. Our patient is a 27-year-old healthy primigravida patient with severe pre-eclampsia undergoing uncomplicated cesarean section due to abnormal kidney function and worsening hypertension. Postoperatively, she developed Purtscher-like retinopathy with profound macular ischemia and count-finger only vision. Neuroimaging was unrevealing. Her postoperative course was significant for hyponatremia, acute kidney injury, ileus, pancreatitis, leukocytosis, and postoperative fevers with suspected septic pelvic thrombophlebitis. The resultant visual acuity overall improved, but remained limited to 20/150 and 20/250 at 3 months postpartum. Purtscher-like retinopathy in the setting of pre-eclampsia can result in vision loss even in the absence of findings on neuroimaging or presence of HELLP syndrome. J Clin Gynecol Obstet. 2016;5(3):97-99 doi: http://dx.doi.org/10.14740/jcgo410w

Postpartum Akut Karın Ayırıcı Tanısında Septik Pelvik Tromboflebit

Akut batın; travma dışı nedenlerle ortaya çıkan, akut başlangıçlı, karın ağrısının ön planda olduğu, acil tedavi gerektiren patolojilerin genel adıdır. Septik pelvik tromboflebit ise pelvik enfeksiyonunun ciddi fakat nadir bir komplikasyonudur. Obstetrik olgularda jinekolojik olgulardan daha sık ortaya çıkar. Spesifik bir semptomu yoktur ve sıklıkla akut karın tablosu ile prezente olur. Tanı ve tedavide geç kalınır ya da unutulur ise ciddi ve mortal seyredebilecek komplikasyonlara neden olabilir. Tanı genelde tek başına antibiyotik tedavisine yanıt vermeyen, fakat antibiyotik ve antikoagülan tedavi kombinasyonuna yanıt veren yüksek ateş ve karın ağrısının varlığıyla geriye dönük konulur. Bilgisayarlı tomografi ve manyetik rezonans görüntüleme tanıda yardımcıdır. Tedavide geniş spektrumlu antibiyotiklere ek olarak antikoagülan tedavi önerilir. Bu çalışmada, postpartum dönemede akut karın tablosunu taklit eden septik pelvik tromboflebitli bir olgu sunulmuştur. Acute abdomen is general definition of pathologies with foreground abdominal pain which are acute initiated without trauma and requires immediate treatment. Septic pelvic thrombophlebitis is a serious but rare complication of pelvic infection. It appears more often on obstetric patients than gynecological patients. There is no specific symptom and often presented as acute abdomen. If the diagnosis and treatment are delaed it may cause serious and mortal complications. Diagnosis is mostly possible retrospectively with pyrexia and abdominal pain response to combination of antibiotic and anticoagulant treatment but with no response to antibiotics alone. Computed tomography and magnetic resonance imaging are helpful in diagnosis. In treatment, anticoagulant treatment is suggested in addition to broad-spectrum antibiotics. In our paper, we presented a case with septic pelvic thrombophlebitis which mimics acute abdomen in postpartum period.

Advanced gynecologic laparoscopy in a fast-track ambulatory surgery center.

Background/Objectives:It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols.Methods:Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours.Results:One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up.Conclusions:With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.

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Introduction: 28 y/o African American female, G5P2A3, no significant PMH, presented to ED3 with Right Lower Extremity (RLE) and Right Upper Extremity(RUE) pain, attributed to a motor vehicle crash 12 days prior, from which patient had no significant injury. 14 days prior to admission, home pregnancy test was positive. At time of MVC, ED1 observed fetal heart tones, beta-HCG of 79000. 6 days prior to admission, pain in RUE, fevers, chills and vaginal bleeding. ED2 visit revealed fetal demise, and discharged home with OB/Gyn follow-up. Pt then developed foul smelling clots, dyspnea on exertion, headache, chills, and presented to the ED3. Admitted to ICU with severe sepsis. Treated with IV drugs vancomycin, pip/tazo, clindamycin, and gentamicin. OB/GYN exam revealed no retained products, some cervical motion tenderness, negative vaginal u/s, beta-HCG of 1616. Right shoulder CT revealed inflammatory/infectious process, confirmed with MRI. Contrast CT right hip also concerning for metastatic septic process. CT chest confirmed septic pulmonary emboli. Blood cultures positive in 12 hours, with GPC's in clusters, found to be MRSA. Vaginal and urine cultures were also positive for MRSA. Transthoracic Echocardiogram (TTE) and Transthoracic Echocardiogram (TEE) were negative for endocarditis. TTE with Bubble study however revealed a small right to left atrial shunt, suggestive of patent foramen ovale. Pt continued to spike temperatures on therapeutic antibiotics. CT abd/pelvis with contrast revealed right internal iliac vein thrombus. Pt was started on full dose anticoagulation with enoxaparin for presumed septic pelvic thrombophlebitis. I&D of right shoulder and hip performed on day 7 after admission, with MRSA growth from right shoulder. Pt defervesced and was sent home in good condition, on antibiotics and anticoagulation, with scheduled repeat scans of pelvis to assess the internal iliac vein thrombus. Discussion: This case represents a very rare case of post-spontaneous abortion MRSA septicemia with septic pelvic thrombophlebitis (SPT), septic pulmonary emboli, and pyomyositis. Our theory for this case is possible MVC/trauma/stress induced miscarriage, leading to infected products of conception. Our suspicion is that deep pelvic vein septic thrombophlebitis developed, leading to septic pulmonary emboli. Although the frank bacteremia with MRSA on its own could lead to disseminated abscesses, the presence of a PFO seen on TTE may also have contributed. Our conclusion of SPT arose from persistent febrile episodes, with negative TEE for endocarditis, in a patient with an obvious endovascular source. SPT can present as either ovarian vein thrombophlebitis (OVT) or deep septic pelvic thrombophlebitis. Although OVT presents with abdominal pain, deep SPT generally does not. Much of the literature surrounding SPT stems from papers in the 1970's and earlier. Post-partum persistent fever 4-5 days after initiation of therapeutic antibiotics for infected individuals, elicits the consideration of SPT. Early on, the treatment was surgical ligation of the involved pelvic vessels, be it the ovarian vein, or deep pelvic veins. Studies found that patients with SPT could be treated with anticoagulation, preventing surgical intervention, and defervescence could be obtained. A more recent study in 1999 has questioned whether anticoagulation is necessary as anticoagulation had no impact on defervescence, however, this study included only 15 patients. Our review of the literature showed other studies in which patients were safely treated with anticoagulation, achieving defervescence, which led us to choose enoxaparin for treatment in this case. Deep SPT historically has been a diagnosis of exclusion due to poor imaging modalities. With improving imaging modalities, it is becoming easier to diagnose SPT, however this does not preclude the high degree of suspicion for SPT required on clinicians behalf in post-partum patients with persistent fever.

Postoperative Infections in Obstetrics and Gynecology

Postoperative infection is the most commonly seen complication of surgery in obstetrics and gynecology. The use of antibiotic prophylaxis has greatly decreased though not completely eliminated this adverse outcome. Postoperative infections include wound cellulitis, wound abscess, endomyometritis, pelvic cellulitis, and pelvic abscess. Infections usually manifest as fever and greater than normal postoperative pain. Refractory fevers maybe because of septic pelvic vein thrombophlebitis or maybe noninfectious in origin. Broad-spectrum antibiotics should be initiated as soon as possible when diagnosis of postoperative infection is made; most patients will respond to treatment within 24 to 48 hours when appropriate antibiotics are selected.

The incidence of complications after cesarean section in HIV‐infected women with advanced WHO stages of HIV disease

Prevalence of HIV infection in Ukraine is 1.6% overall, with antenatal prevalence of 0.52%, the highest in Europe. According to national protocol, cesarean section has been recommended for women with viral load above 50 copies/mL to further prevent vertical transmission of HIV. The aim of our study was to compare the infectious complication rates after cesarean delivery in HIV‐infected women with advanced WHO stages of HIV disease who received HAART, and HIV‐infected women with I or II WHO stages.Materials and methodsA retrospective analysis was performed on data derived from 150 HIV‐infected women with advanced WHO stages of HIV disease (group I) and 150 HIV‐infected women with I or II WHO stages (group II), who underwent cesarean delivery. Postoperative infectious morbidity in both groups was analyzed according to whether the cesarean section was an elective or emergent delivery. Descriptive, comparison analyses were performed.ResultsThere was no significant difference between the both groups in terms of gravidity, parity, number of previous cesarean sections, estimated gestational age at time of delivery. It has been shown that HIV‐infected women from the group I have 2 times more factors for the appearance of postpartum infectious complications, such as anemia, the urinary tract infection, sexually transmitted infections. Both groups of women were statistically more likely to experience postpartum endometritis when being delivered by emergent cesarean section than by elective cesarean section (14.6% versus 4.6%, respectively in the group I and 5.3% versus 0.5%, respectively, in the group II), superficial or deep wound breakdown (22.6% versus 4.6%, respectively, in the first group and 5.3% versus 2.6%, respectively, in the second group). Septic pelvic thrombophlebitis was only in 2% of HIV‐infected women from the group I. Urinary tract infection had 25% HIV‐infected women in the both groups. Overall, the rate of postpartum infectious complications in the first group consist 28%, which was 2 times higher compared the second group.ConclusionAccording to our study, there was no significant difference in infectious postoperative morbidity in HIV‐infected women who delivered by elective cesarean section in the both groups. But HIV‐infected women with advanced WHO stages of HIV disease undergoing emergency cesarean section are at increased risk for post‐operative infectious complications.

Prophylactic Use Of Antibiotics In Operative Procedures

Febrile morbidity appears to be an inevitable sequel to operative obstetric procedures in about 10-15% of patients. Apart from endometritis, serious infections such as pelvic abscess, septic shock and septic pelvic vein thrombophlebitis may occur. Patients at risk include those in prolonged labour with ruptured membranes. Obesity is also a risk factor as well as anaemia. Prophylactic use of antibiotics has proven benefits in reducing maternal morbidity following operative procedures. Key words: Antibiotics; Operative Procedures; Prophylaxis