Ovarian Vein Thrombosis in a Non-Puerperal Patient

  • Ena Arora Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA
  • Vaidehi Mujumdar Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA
  • Alexander Martin Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
  • Sandeep Tuli Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA

Keywords

Ovarian vein thrombosis, anticoagulation, gynaecological surgery

Abstract

Ovarian vein thrombosis (OVT) is a relatively rare, but serious disease more commonly seen in puerperal patients. In the postpartum period, there is an unequal incidence of OVT in women with vaginal delivery (0.18%) and caesarean section (2.0%).OVT is usually associated with other conditions like pelvic inflammatory disease, malignant tumours, sepsis, enteritis, and recent pelvic or abdominal surgery. The incidence of idiopathic OVT is extremely rare and only a few cases have been reported to date in healthy patients with unknown aetiology. Patients with OVT present with abdominal pain, nausea, vomiting, fever or abdominal mass. Complications of OVT include pulmonary embolism, ovarian infarction, sepsis and death. CT scanning of the abdomen provides reliable evidence for the diagnosis of idiopathic OVT. Thrombus in most patients with idiopathic OVT is located in the right ovarian vein. This may be due to the longer length of the right ovarian vein, right shift of the uterus and relative insufficiency of the right ovarian vein valve. Treatment of OVT includes systemic anticoagulation which will achieve resolution of symptoms and prevent life-threatening complications. Our case report documents a non-puerperal patient who underwent hysterectomy a year before presenting to the ED with complaints of diarrhoea and found to have OVT on a CT scan. Our case brings attention to the fact that OVT can occur outside the puerperium and might present as a rare complication of minimally invasive surgeries for endometrial cancer. Furthermore, we posit that OVT in the non-puerperal patient may be a separate clinical entity.

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References

  • Djakovic I, Mustapic M, Marleku F, Grgic O, Djakovic Z, Kosec V. Ovarian vein thrombosis—a case report. Acta Clinica Belgica 2015;70(6):445–446. doi: 10.1179/2295333715Y.0000000049.
  • Doherty K, New M. Idiopathic ovarian vein thrombosis in a non-peripartum patient. Obstet Gynecol 2015;125(6):1468–1470.
  • Stafford M, Fleming T, Khalil A. Idiopathic ovarian vein thrombosis: a rare cause of pelvic pain—case report and review of literature. Aust N Z J Obstet Gynaecol 2010;50(3):299–301. doi: 10.1111/j.1479-828x.2010.01159.
  • Kearon C. Diagnosis of pulmonary embolism. CMAJ 2003 Jan;16(2):183–194.
  • De Cuyper K, Eyselbergs M, Bernard P, Clabout L, Vanhoenacker FM. Added value of diffusion weighted MR imaging in the diagnosis of postpartum ovarian vein thrombosis. JBR-BTR 2014;97(4):242–244.
  • Bilgin M, Sevket O, Yildiz S, Sharifov R, Kocakoc E. Imaging of postpartum ovarian vein thrombosis. Case Rep Obstet Gynecol 2012;2012:4. doi: 10.1155/2012/134603.134603.
  • Togan T, Turan H, Cifci E, Çiftci C. Ovarian and renal vein thrombosis: a rare cause of fever outer the postpartum period. Case Rep Obstet Gynecol 2015;2015:4. doi: 10.1155/2015/817862.817862.
  • Akinbiyi AA, Nguyen R, Katz M. Postpartum ovarian vein thrombosis: two cases and review of literature. Case Rep Med 2009;2009:4. doi: 10.1155/2009/101367.101367.
  • Tait C, Baglin T, Watson H, Laffan M, Makris M, Perry D, et al.; British Committee for Standards in Haematology. Guidelines on the investigation and management of venous thrombosis at unusual sites. Br J Haematol 2012;159:28–38.
  • Janczak DT, Mimier MK, McBane RD, Kamath PS, Simmons BS, Bott-Kitslaar DM, et al. Rivaroxaban and apixaban for initial treatment of acute venous thromboembolism of atypical location. Mayo Clin Proc 2018;93:40–47.
  • Covut F, Kewan T, Perez O, Thapa B, Babar A, Alomari M, et al. Direct oral anticoagulants versus warfarin and enoxaparin in ovarian vein thrombosis. Am J Ther 2021;28(2):e260–e263.
  • Ferman D, Bradley TP, Warshawsky R, Allen SL. Nonpuerperal ovarian vein thrombosis: a report of seven cases. Blood 2004;104(11):4038.
  • Published: 2022-05-16

    Issue: 2022: Vol 9 No 5 (view)

    Section: Articles

    How to cite:
    1.
    Arora E, Mujumdar V, Martin A, Tuli S. Ovarian Vein Thrombosis in a Non-Puerperal Patient. EJCRIM 2022;9 doi:10.12890/2022_003351.