Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
Ovarian vein thrombosis – a case report I. Djakovic, M. Mustapic, F. Marleku, O. Grgic, Z. Djakovic & V. Kosec To cite this article: I. Djakovic, M. Mustapic, F. Marleku, O. Grgic, Z. Djakovic & V. Kosec (2015) Ovarian vein thrombosis – a case report, Acta Clinica Belgica, 70:6, 445-446, DOI: 10.1179/2295333715Y.0000000049 To link to this article: http://dx.doi.org/10.1179/2295333715Y.0000000049
Published online: 26 Oct 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [University of California, San Diego]
Date: 14 December 2016, At: 08:54
Case Report
Ovarian vein thrombosis – a case report I. Djakovic1, M. Mustapic2, F. Marleku2 , O. Grgic1, Z. Djakovic3 , V. Kosec1 1
Department of Gynecology and Obstetrics, University Hospital Centre ‘Sestre milosrdnice’, Zagreb, Croatia, Department of Diagnostic and Interventional Radiology, University Hospital Centre ‘Sestre Milosrdnice’, Zagreb, Croatia, 3Department of Thoracic Surgery ‘Jordanovac’, University Hospital Centre Zagreb, Croatia
2
Objective and importance: Ovarian vein thrombosis is a rare condition usually seen in the puerperium. The incidence is 0.05–0.18% of pregnancies. Possible complications of ovarian vein thrombosis are sepsis, thrombus extension into the inferior vena cava or renal veins and pulmonary embolism. Clinical presentation: A 31-year-old puerpera complained about abdominal pain in the right lower quadrant and right inguinal region. Intervention: Ultrasonographic examination and multislice computed tomography (MSCT) revealed the right ovarian vein thrombosis. Patient was treated with low-molecular weight heparin and antibiotics for 2 weeks. She was discharged with oral anticoagulants for 6 months. Conclusion: Ovarian vein thrombosis should be taken under consideration in the post-partum period. Keywords: Ovarian vein thrombosis, Puerperium, Puerpera, Sepsis, Pulmonary Embolism
Introduction Venous thromboembolism constitutes the leading cause of direct maternal mortality in the developed world.1 Ovarian vein thrombosis is a rare condition usually seen in puerperium. The incidence is 0.05–0.18% of pregnancies.2 Right ovarian vein is affected in 80–90% of the cases and about 10–15% of the cases are bilateral. It can lead to a serious, life treating condition. Possible complications of ovarian vein thrombosis are sepsis, thrombus extension into the inferior vena cava or renal veins and pulmonary embolism. The incidence of pulmonary embolism is 13.2% with 4% mortality.2 Treatment requires a multidisciplinary approach.3
Case report A 31-year-old woman gave birth to her third child, a male newborn weighting 3950 g and 52 cm in length with Apgar score 10/10. The pregnancy was without complications. On the third day after delivery, she complained about abdominal pain in the right lower quadrant and right inguinal region. Ultrasonographic examination revealed a floating thrombus in the inferior vena cava measuring 16 mm. It was confirmed by multislice computed tomography (MSCT) and the right ovarian vein was found completely closed by a thrombus (Fig. 1). Patient was treated with Correspondence to: Ivka Djakovic´, Department of Gynecology and Obstetrics, University Hospital Centre ‘Sestre milosrdnice’, Vinogradska 29, Zagreb, Croatia. Email: [email protected]
ß Acta Clinica Belgica 2015
DOI 10.1179/2295333715Y.0000000049
low-molecular weight heparin and antibiotics for 2 weeks. She was discharged with oral anticoagulants for 6 months.
Discussion Risk factors for ovarian vein thrombosis are the peurperium, multiparity, the postoperative period, but also a presence of other conditions like Crohn’s disease, systemic lupus, malignancy, thrombophilia and hyperhomocysteinemia.4 Venous stasis due to compression of the inferior vena cava by the pregnant uterus, endothelial trauma during delivery or local inflammation and a hypercoagulable state are all associated with pregnancy.2 Symptoms are pain in right lower quadrant, fever and leukocytosis usually appearing the first 10 days after delivery. These symptoms are non-specific. Due to a wide range of mimicking conditions and the relative rarity of this complication, a significant delay is often observed from the onset of symptoms to the start of the proper treatment. Diagnostic errors are frequent.5 In our case, the surgeons doubted about hernia or appendicitis. Our patient had no fever. As in our case, ovarian vein thrombosis is usually suspected after ultrasonographic examination and confirmed by MSCT. Khalil et al. using magnetic resonance venography in the early postpartum period in patients at low risk for thrombosis found a high prevalence of intraluminal filling defects in asymptomatic patients.1
Acta Clinica Belgica
2015
VOL .
70
NO .
6
445
Djakovic et al.
Ovarian vein thrombosis
Anticoagulant therapy should be accompanied by wide spectrum antibiotics.
Disclaimer Statements Contributors All authors equally contributed to the manuscript. Funding None. Conflict of interest We certify there is no conflict of interest with any financial organisation regarding the material discussed in the manuscript. Ethics approval Ethical approval was not required.
References
Figure 1 Coronal reconstructed multislice computed tomography (MSCT) image shows extensive right ovarian vein thrombosis with propagation into the inferior vena cava
Ovarian vein thrombosis should be taken into consideration when confronted with an acute abdomen in the postpartum period. Diagnostic exploration should include ultrasonographic examination and computed tomography of the abdomen.
446
Acta Clinica Belgica
2015
VOL .
70
NO .
6
1 Khalil H, Avruch L, Olivier A, Walker M, Rodger M. The natural history of pelvic vein thrombosis on magnetic resonance venography after vaginal delivery. Am J Obstet Gynecol. 2012;206(4):356e1–356e4. 2 Arkadopoulos N, Dellaportas D, Yiallourou A, Koureas A, Voros D. Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review. World J Emerg Surg. 2011;6(1):45. 3 Bhandari HM, Jeevan D, Slinn J, Goswami K. Postpartum ovarian vein thrombosis in a 29-year-old woman with ulcerative colitis. BMJ Case Rep. 2014;2014, pii: bcr2014206452. 4 Takach TJ, Carvera RD, Gregoric ID. Ovarian vein and caval thrombosis. Tex Heart Inst J. 2005;32(4):579–82. 5 Paulowitz HP, Fenzl G, Spitzer D, Sattlegger P, Lundwall K. Postopartum ovarian vein thrombosis - case report. Wien Med Wochenschr. 1994;144(10-11):280–82.
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
Ovarian vein thrombosis – a case report I. Djakovic, M. Mustapic, F. Marleku, O. Grgic, Z. Djakovic & V. Kosec To cite this article: I. Djakovic, M. Mustapic, F. Marleku, O. Grgic, Z. Djakovic & V. Kosec (2015) Ovarian vein thrombosis – a case report, Acta Clinica Belgica, 70:6, 445-446, DOI: 10.1179/2295333715Y.0000000049 To link to this article: http://dx.doi.org/10.1179/2295333715Y.0000000049
Published online: 26 Oct 2016.
Submit your article to this journal
Article views: 2
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [University of California, San Diego]
Date: 14 December 2016, At: 08:54
Case Report
Ovarian vein thrombosis – a case report I. Djakovic1, M. Mustapic2, F. Marleku2 , O. Grgic1, Z. Djakovic3 , V. Kosec1 1
Department of Gynecology and Obstetrics, University Hospital Centre ‘Sestre milosrdnice’, Zagreb, Croatia, Department of Diagnostic and Interventional Radiology, University Hospital Centre ‘Sestre Milosrdnice’, Zagreb, Croatia, 3Department of Thoracic Surgery ‘Jordanovac’, University Hospital Centre Zagreb, Croatia
2
Objective and importance: Ovarian vein thrombosis is a rare condition usually seen in the puerperium. The incidence is 0.05–0.18% of pregnancies. Possible complications of ovarian vein thrombosis are sepsis, thrombus extension into the inferior vena cava or renal veins and pulmonary embolism. Clinical presentation: A 31-year-old puerpera complained about abdominal pain in the right lower quadrant and right inguinal region. Intervention: Ultrasonographic examination and multislice computed tomography (MSCT) revealed the right ovarian vein thrombosis. Patient was treated with low-molecular weight heparin and antibiotics for 2 weeks. She was discharged with oral anticoagulants for 6 months. Conclusion: Ovarian vein thrombosis should be taken under consideration in the post-partum period. Keywords: Ovarian vein thrombosis, Puerperium, Puerpera, Sepsis, Pulmonary Embolism
Introduction Venous thromboembolism constitutes the leading cause of direct maternal mortality in the developed world.1 Ovarian vein thrombosis is a rare condition usually seen in puerperium. The incidence is 0.05–0.18% of pregnancies.2 Right ovarian vein is affected in 80–90% of the cases and about 10–15% of the cases are bilateral. It can lead to a serious, life treating condition. Possible complications of ovarian vein thrombosis are sepsis, thrombus extension into the inferior vena cava or renal veins and pulmonary embolism. The incidence of pulmonary embolism is 13.2% with 4% mortality.2 Treatment requires a multidisciplinary approach.3
Case report A 31-year-old woman gave birth to her third child, a male newborn weighting 3950 g and 52 cm in length with Apgar score 10/10. The pregnancy was without complications. On the third day after delivery, she complained about abdominal pain in the right lower quadrant and right inguinal region. Ultrasonographic examination revealed a floating thrombus in the inferior vena cava measuring 16 mm. It was confirmed by multislice computed tomography (MSCT) and the right ovarian vein was found completely closed by a thrombus (Fig. 1). Patient was treated with Correspondence to: Ivka Djakovic´, Department of Gynecology and Obstetrics, University Hospital Centre ‘Sestre milosrdnice’, Vinogradska 29, Zagreb, Croatia. Email: [email protected]
ß Acta Clinica Belgica 2015
DOI 10.1179/2295333715Y.0000000049
low-molecular weight heparin and antibiotics for 2 weeks. She was discharged with oral anticoagulants for 6 months.
Discussion Risk factors for ovarian vein thrombosis are the peurperium, multiparity, the postoperative period, but also a presence of other conditions like Crohn’s disease, systemic lupus, malignancy, thrombophilia and hyperhomocysteinemia.4 Venous stasis due to compression of the inferior vena cava by the pregnant uterus, endothelial trauma during delivery or local inflammation and a hypercoagulable state are all associated with pregnancy.2 Symptoms are pain in right lower quadrant, fever and leukocytosis usually appearing the first 10 days after delivery. These symptoms are non-specific. Due to a wide range of mimicking conditions and the relative rarity of this complication, a significant delay is often observed from the onset of symptoms to the start of the proper treatment. Diagnostic errors are frequent.5 In our case, the surgeons doubted about hernia or appendicitis. Our patient had no fever. As in our case, ovarian vein thrombosis is usually suspected after ultrasonographic examination and confirmed by MSCT. Khalil et al. using magnetic resonance venography in the early postpartum period in patients at low risk for thrombosis found a high prevalence of intraluminal filling defects in asymptomatic patients.1
Acta Clinica Belgica
2015
VOL .
70
NO .
6
445
Djakovic et al.
Ovarian vein thrombosis
Anticoagulant therapy should be accompanied by wide spectrum antibiotics.
Disclaimer Statements Contributors All authors equally contributed to the manuscript. Funding None. Conflict of interest We certify there is no conflict of interest with any financial organisation regarding the material discussed in the manuscript. Ethics approval Ethical approval was not required.
References
Figure 1 Coronal reconstructed multislice computed tomography (MSCT) image shows extensive right ovarian vein thrombosis with propagation into the inferior vena cava
Ovarian vein thrombosis should be taken into consideration when confronted with an acute abdomen in the postpartum period. Diagnostic exploration should include ultrasonographic examination and computed tomography of the abdomen.
446
Acta Clinica Belgica
2015
VOL .
70
NO .
6
1 Khalil H, Avruch L, Olivier A, Walker M, Rodger M. The natural history of pelvic vein thrombosis on magnetic resonance venography after vaginal delivery. Am J Obstet Gynecol. 2012;206(4):356e1–356e4. 2 Arkadopoulos N, Dellaportas D, Yiallourou A, Koureas A, Voros D. Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review. World J Emerg Surg. 2011;6(1):45. 3 Bhandari HM, Jeevan D, Slinn J, Goswami K. Postpartum ovarian vein thrombosis in a 29-year-old woman with ulcerative colitis. BMJ Case Rep. 2014;2014, pii: bcr2014206452. 4 Takach TJ, Carvera RD, Gregoric ID. Ovarian vein and caval thrombosis. Tex Heart Inst J. 2005;32(4):579–82. 5 Paulowitz HP, Fenzl G, Spitzer D, Sattlegger P, Lundwall K. Postopartum ovarian vein thrombosis - case report. Wien Med Wochenschr. 1994;144(10-11):280–82.
