Ovarian vein thrombosis: a rare but not to be forgotten cause of abdominal pain

A healthy 38-year-old woman, with no significant medical or surgical history, was referred to the gynaecology emergency department with acute low quadrant abdominal pain and nausea. On examination, painful palpation of right iliac fossa, abdominal guarding and positive Blumberg’s sign were noted. An abdominal-pelvic CT scan showed a hypodense tubular structure with peripheral enhancement to the right of the inferior vena cava, suggestive of thrombosis of the right ovarian vein. The only risk factor identified was the use of the combined contraceptive pill.

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Ovarian vein thrombosis in the postnatal period

BMJ Case Reports ◽

10.1136/bcr-2021-243872 ◽

2021 ◽

Vol 14 (6) ◽

pp. e243872

Author(s):

Louise Dunphy ◽

Aie Wei Tang

Keyword(s):

Abdominal Pain ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Elective Caesarean Section ◽

Vena Cava ◽

Lower Abdominal Pain ◽

Ovarian Vein ◽

Vein Thrombosis ◽

The Right ◽

Ovarian Vein Thrombosis

Although ovarian vein thrombosis (OVT) is classically considered a puerperal pathology, it can also occur in nonpuerperal settings such as endometritis, pelvic inflammatory disease, Crohn’s disease, pelvic or gynaecological surgeries and thrombophilia. Hypercoagulation conditions such as antiphospholipid syndrome, systemic lupus erythematosus, factor V Leiden and protein C and S deficiency are all recognised risk factors. It is also a known complication during pregnancy often presenting with fever and lower abdominal pain within weeks after delivery. Its incidence is exceedingly rare, occurring in 0.05% of all pregnancies that result in live births and peaking around 2–6 days after delivery. Its preferential involvement of the right ovarian vein may be explained by the compression of the inferior vena cava and the right ovarian vein due to dextrorotation of the uterus during pregnancy. Furthermore, antegrade flow of blood and multiple incompetent valves in the right ovarian vein favours bacterial infection. Complications may include sepsis and thrombus extension to the inferior vena cava or left renal vein and rarely, pulmonary embolism. The authors present the case of a 27-year-old woman with lower abdominal pain 5 weeks after an elective caesarean section. Although the diagnosis of postpartum endometritis was initially considered, a CT suggested a right OVT. She commenced treatment with low-molecular weight heparin. A high index of clinical suspicion is required in order to establish the diagnosis of this rare cause of abdominal pain, which can mimic an acute abdomen.

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Postpartum ovarian vein thrombosis

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2020-5-147-149 ◽

2020 ◽

Vol 19 (5) ◽

pp. 147-149

Author(s):

O.V. Papysheva ◽

◽

A.E. Voynovskiy ◽

A.I. Davydov ◽

M.B. Tairova ◽

...

Keyword(s):

Postpartum Period ◽

Clinical Case ◽

Inferior Vena ◽

Vena Cava ◽

Ovarian Vein ◽

Large Fragment ◽

Renal Veins ◽

Vein Thrombosis ◽

The Right ◽

Ovarian Vein Thrombosis

A clinical case of thrombosis of the right ovarian vein in the postpartum period - an extremely rare pathology in which acute appendicitis is often suspected due to the identity of the symptoms of the diseases. Performed laparoscopy, during which a large fragment of a thrombosed vein was excised. Conclusion. Extensive right ovarian vein thrombosis with a normal hemostasiogram could not only not be resolved by anticoagulants, but also potentially spread to the renal veins and inferior vena cava, increasing the risk of pulmonary embolism. Key words: vein dissection, laparoscopy, postpartum period, ovarian vein thrombosis

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Nonpuerperal Ovarian Vein Thrombosis: A Report of Seven Cases.

Blood ◽

10.1182/blood.v104.11.4038.4038 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4038-4038

Author(s):

Debra Ferman ◽

Thomas P. Bradley ◽

Robin Warshawsky ◽

Steven L. Allen

Keyword(s):

Abdominal Pain ◽

Family History ◽

Vena Cava ◽

Lower Abdominal Pain ◽

Clinical Entity ◽

Ovarian Vein ◽

Symptomatic Disease ◽

Vein Thrombosis ◽

History Of ◽

Ovarian Vein Thrombosis

Abstract Background: Nonpuerperal ovarian vein thrombosis (OVT) is a rare clinical entity. Therapy is not well defined. OVT is usually asymptomatic. Improved CT and MR imaging technology enables OVT to be diagnosed with greater frequency. Nonpuerperal OVT may be a distinct clinical entity. Methods: The medical records of women with nonpuerperal OVT were reviewed and their clinical course and treatment recorded. Cases were identified by scanning a CT computerized database over the past 3 years with the key words ovarian vein thrombosis. Results: 7 patients (pts) were identified. Age range was 38–61, median 51 years. 3 pts had OVT on the left and 4 on the right. OVT followed a procedure in 2 pts. 2 pts with breast cancer developed OVT, 1 during adjuvant tamoxifen and 1 receiving chemotherapy for metastatic disease. 1 pt had AML in CR. 3 pts presented with lower abdominal pain on the involved side and 1 pt had lower abdominal pain on the opposite side. The 3 pts with cancer were asymptomatic. 4 pts had uterine fibroids. 1 developed OVT in the setting of an acute diarrheal illness. 1 pt had prior DVT and 1 a family history of DVT. Only 1 pt had a hypercoagulable evaluation; negative. 2 pts had clot extending to the junction with the inferior vena cava (IVC) and both were anticoagulated with enoxaparin followed by warfarin. 1 pt was anticoagulated with enoxaparin alone. No embolic complications occurred. Conclusion: 4 pts with OVT were symptomatic and 3 were detected incidentally. 2 developed OVT following procedures, 3 had predisposing underlying conditions, and 2 had a personal or family history of thrombosis. Optimum therapy is not defined. Symptomatic disease alone is not an indication for anticoagulation. Anticoagulation may be indicated if clot extends to the IVC.

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Ovarian vein thrombosis: a potential clinical consequence of ruptured ectopic pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-240940 ◽

2021 ◽

Vol 14 (4) ◽

pp. e240940

Author(s):

David Elliot Teytelbaum ◽

Josh Dean Meade ◽

Jennifer Swanson

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Ectopic Pregnancy ◽

Clinical Consequence ◽

Ovarian Vein ◽

Timely Manner ◽

Vein Thrombosis ◽

Life Threatening ◽

The Right ◽

Ovarian Vein Thrombosis

A healthy 32-year-old G3P3 woman with an unknown last menstrual period presented to the emergency department with intense abdominal pain and pain in the right chest that radiated down the right arm. Further workup showed that she had a ruptured ectopic pregnancy with significant haemoperitoneum. After successful laparoscopic evacuation of the ectopic pregnancy and haemoperitoneum, the patient subsequently developed a right ovarian vein thrombosis 4 weeks after the procedure. She was treated with anticoagulation, and further haematological studies did not show any significant findings. Postpartum ovarian vein thrombosis is extremely rare and can be life- threatening if not accurately diagnosed and treated with anticoagulation or surgical management in a timely manner.

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Idiopathic ovarian vein thrombosis causing pulmonary embolism: case report and literature review

Journal of International Medical Research ◽

10.1177/03000605211010649 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110106

Author(s):

Wenrui Li ◽

Saisai Cao ◽

Renming Zhu ◽

Xueming Chen

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Abdominal Pain ◽

Case Report ◽

Literature Review ◽

Ovarian Vein ◽

Review Of Literature ◽

Vein Thrombosis ◽

Medical Disorder ◽

Ovarian Vein Thrombosis

Ovarian vein thrombosis (OVT) is a rare medical disorder, which is most often found in the immediate postpartum period. OVT is rarely considered idiopathic. We report a case of idiopathic OVT with pulmonary embolism in a 33-year-old woman who presented with abdominal pain. Computed tomography and postoperative pathology confirmed the diagnosis of idiopathic OVT. To date, only 12 cases of idiopathic OVT have been reported. In this case report, we present a summary of these cases and a review of literature regarding management of idiopathic OVT.

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Postpartum ovarian vein thrombosis

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2021-0002 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Kelly Ribeiro ◽

Samir Mahboobani ◽

Katherine Van Ree ◽

Katy Clifford ◽

TG Teoh

Keyword(s):

Abdominal Pain ◽

Complete Resolution ◽

Early Recognition ◽

Ovarian Vein ◽

Transabdominal Ultrasound ◽

Case Presentation ◽

Vein Thrombosis ◽

Prompt Treatment ◽

Life Threatening ◽

Ovarian Vein Thrombosis

Abstract Objectives Postpartum ovarian vein thrombosis (POVT) is a rare pathology that can lead to severe complications such as sepsis, extension of the thrombus leading to organ failure, and pulmonary embolism. It therefore requires early recognition and prompt treatment. Case presentation A patient with right POVT presented four days after delivery with acute right-sided abdominal pain and fever. Appendicitis was initially considered, before an abdominal-pelvic computed tomography raised the suspicion of POVT, subsequently confirmed through transabdominal ultrasound. Antibiotics and anticoagulation were initiated, with rapid clinical improvement and complete resolution of the thrombus three months later. Conclusions Diagnosing POVT is challenging as it clinically mimics other more frequent conditions. It is rare but life-threatening and should be considered in all females presenting with abdominal pain and fever in the postpartum period.

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Postpartum Ovarian Vein and Inferior Vena Cava Thrombosis

Case Reports in Medicine ◽

10.1155/2014/609187 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Harun Arslan ◽

Sibel Ada ◽

Sebahattin Çelik ◽

Tayfur Toptaş

Keyword(s):

Inferior Vena ◽

Rare Complication ◽

Vena Cava ◽

Ovarian Vein ◽

Pelvic Infection ◽

Vein Thrombosis ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis ◽

Ovarian Abscess ◽

Ovarian Vein Thrombosis

Postpartum ovarian vein thrombosis (POVT), which generally occurs 2–15 days postpartum, is a rare complication. It can be confused with acute appendicitis, pelvic infection, ovarian torsion, tubo-ovarian abscess, and pyelonephritis. It is associated with morbidity and mortality. Here, we present a patient with postpartum OVT and IVC diagnosed by US and CT findings. She was treated successfully with no further need for any interventional procedures.

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