Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review

World Journal of Emergency Surgery

Dionysios Voros²  Andreas Koureas¹  Anneza Yiallourou²  Dionysios Dellaportas²  Nikolaos Arkadopoulos² 

[1] 1st Department of Radiology, Athens University School of Medicine, Aretaieion Hospital, Athens, Greece;2nd Department of Surgery, Athens University School of Medicine, Aretaieion Hospital, Athens, Greece

关键词: appendectomy;    appendicitis;    postpartum;    thrombosis;    ovarian vein;   

Others  :  792549
DOI  :  10.1186/1749-7922-6-45

 received in 2011-07-28, accepted in 2011-12-23,  发布年份 2011

【 摘 要 】

Background

Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.

Case presentation

A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.

Discussion

Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT.

Conclusions

OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.

【 授权许可】

   
2011 Arkadopoulos et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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