Postpartum ovarian vein thrombosis

Abstract

Background: Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side in 80% to 90% of the cases.

Case report: A 32-year-old woman presented at 15 days postpartum to our emergency department with severe abdominal pain, fever, and abdominal distension. Abdominal examination revealed right lower quadrant pain with rebound tenderness. The plain abdominal radiography evidenced a diffuse fecal stasis; abdominal ultrasound showed the presence of free fluid in the Douglas' pouch and between small bowel loops. Diagnosis of acute appendicitis was made. The patient immediately underwent explorative laparoscopy; at surgery, a woody tumoration consistent with right ovarian vein thrombosis was found. Laparoscopic ultrasound confirmed the diagnosis. Anticoagulation therapy and antibiotics were instituted. CT-scan confirmed the presence of thrombosis up to the vena cava. The patient was discharged on postoperative day 4. At 1-month follow-up, she remained stable and symptom free.

Discussion: Even though postpartum ovarian vein thrombosis is rare, recognition and treatment is needed to institute adequate therapy and avoid potential serious sequelae. The diagnosis can be established by ultrasound, CT scan, and MRI examinations, although, as in the case described, the limitation of ultrasound includes obscuration of the gonadic vein by overlying bowel gas.

Conclusion: OVT should be considered in any woman in the postpartum period with lower abdominal pain, fever, and leucocytosis.

Figure 1.

Laparoscopic exploration highlights the presence of a woody tumoration at the level of right ovarian vein.

Figure 2.

Laparoscopic cross-section ultrasound image shows the presence of a tubular anechoic-to-hypoechoic structure, with absence of flow on Doppler US interrogation.

Figure 3.

CT coronal demonstrates an enlarged ovarian vein with central hypodensity, representing thrombosis (arrow).

Figure 4.

CT coronal shows the extension of the thrombus up to the vena cava (arrow).