Massive acute haemoperitoneum and shock from a ruptured ovarian varix

Takehara, Nobuharu; Takashimizu, Ikkei; Yazawa, Kazuyuki

doi:10.1136/bcr.03.2012.6028

Cited by 1 publication

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“…Spontaneous rupture of the ovarian vein was, in one case, caused by an abnormal vascular network associated with liver cirrhosis in a patient with a history of ruptured esophageal varices [ 7 ], and in a few cases of utero-ovarian vein rupture associated with pregnancy [ 8 , 9 ]. The only case of reported rupture of the gonadal vein as a result of NCS was spontaneous varicocele rupture in a man [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

2021

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Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

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Section: Discussionmentioning

confidence: 99%