Puerperal Ovarian Vein Thrombosis with Extension into the Inferior Vena Cava

Abstract

The incidence of puerperal ovarian vein thrombosis is estimated to range between 1 in 600 and 1 in 2000 deliveries. The cardinal signs of puerperal ovarian vein thrombosis include fever, leukocytosis, and right lower quadrant abdominal pain, most often in a recently delivered female patient. These patients are classically described as failing to improve with intravenous antibiotic therapy alone; resolution of symptoms and presumptive diagnosis is made on defervescence with the addition of intravenous heparin therapy. Objective diagnostic modalities include venography, ultrasound, laparoscopy, and MRI, although CT remains the gold standard for the identification of this underdiagnosed entity. We present a case report of a 20-year-old female treated at our facility for puerperal ovarian vein thrombosis. She was transferred to our vascular surgery service after developing the classic signs of puerperal ovarian vein thrombosis and undergoing CT demonstrating ovarian vein thrombosis with extension of free-floating thrombus into her inferior vena cava (IVC). This degree of thrombosis was particularly concerning when one considers the 3 to 33 per cent rate of pulmonary embolism reported in patients with puerperal ovarian vein thrombosis. Treatment modalities for such extensive degrees of thrombosis are described in the literature and range from hysterectomy and thrombectomy to ligation of the IVC. In our case, we prophylactically placed a suprarenal IVC Greenfield filter to protect against pulmonary embolism and proceeded with the standard regimen of anticoagulation and antibiotics. This treatment approach has been reported only twice previously in the literature, to our knowledge.

Ovarian Vein Thrombosis, Critical Diagnosis at Al-Hasahisa Obstetrics & Gynecology Teaching Hospital in Geziera State, Sudan

“…The mortality from OVT can be as high as 5% and is mostly due to pulmonary embolism with an incidence reported to be up to 13.2% [14]. If the patient fails to respond to standard medical treatment or severe complications occur, options range from the placement of an inferior vena cava Greenfield filter, hysterectomy and thrombectomy or even ligation of the inferior vena cava [15]. The duration of anticoagulation therapy is controversial.…”

Ovarian Vein Thrombosis

“…66,71,77,78,90,105,133,149 One patient was treated with antiplatelet treatment with aspirin. 101 IVC filter was implanted in 6 patients 40,42,58,75,85,133,164 and surgical treatment with ligation was performed in 23 patients. 22,38,53,61,63,76,80,83,84,88,[95][96][97]100,113,114,116,117,123,160,163 Septic thrombophlebitis was demonstrated in few cases with positive cultures (Table 3).…”