Puerperal ovarian vein thrombosis accompanied by hydronephrosis
Abstract
Three weeks after delivery, a 22-year old woman presented to urology with fever, abdominal and right-sided flank pain. Hydronephrosis was diagnosed with iv-pyelography and treated with JJ-stent drainage and antibiotics for suspected pyelonephritis. On the third day oedema of the right leg appeared, which prompted further investigations. CT identified ovarian vein thrombosis as a cause of hydronephrosis, and further thrombosis of the inferior vena cava, iliacal and deep veins of both upper legs. Anticoagulant treatment with low-molecular-weight-heparin and later warfarin resulted in partial recanalisation of thrombi.
The patient is double heterozygous for factor V Leiden and prothrombin mutation. Although recent literature negates this as a significant risk factor, presence of other, more obvious and easily recognizable risk factors (previous spontaneous abortions, smoking, bed rest, obesity, non-O blood group...) should have prompted detailed
risk evaluation and consideration of thromboprophylaxis.Ovarian vein thrombophlebitis should be suspected in any postpartum patient with unexplained fever and abdominal pain.
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References
Graupera B, Pascual MA, Garcia P, Di Paola R, Ubeda B, Tresserra F. Atypical ultrasonographic presentation of ovarian vein thrombosis. Eur J Gynaecol Oncol 2011; 32(4): 439–40.
De Stefano V, Martinelli I. Abdominal thromboses of splanchnic, renal and ovarian veins. Venous Thromboembolism Adv Controv 2012; 25(3): 253–64.
Heavrin BS, Wrenn K. Ovarian vein thrombosis: a rare cause of abdominal pain outside the peripartum period. J Emerg Med 2008; 34(1): 67–9.
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.
Takach TJ, Cervera RD, Gregoric ID. Ovarian vein and caval thrombosis. J Tex Heart Inst 2005; 32(4): 579–82.
Gakhal MS, Levy HM, Spina M, Wrigley C. Ovarian vein thrombosis: analysis of patient age, etiology, and side of involvement. Del Med J 2013; 85(2): 45–50.
Basili G, Romano N, Bimbi M, Lorenzetti L, Pietrasanta D, Goletti O. Postpartum ovarian vein thrombosis. JSLS 2011; 15(2): 268–71.
Jassal DS, Fjeldsted FH, Smith ER, Sharma S. A diagnostic dilemma of fever and back pain postpartum. Chest 2001; 120(3): 1023–4.
Virmani V, Kaza R, Sadaf A, Fasih N, Fraser-Hill M. Ultrasound, computed tomography, and magnetic resonance imaging of ovarian vein thrombosis in obstetrical and nonobstetrical patients. J Assoc Can Radiol 2012; 63(2): 109–18.
Bilgin M, Sevket O, Yildiz S, Sharifov R, Kocakoc E. Imaging of postpartum ovarian vein thrombosis. Case Reports Obstet Gynecol 2012: 134603.
Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46(7): 415–27.
Collins CG. Suppurative pelvic thrombophlebitis. A study of 202 cases in which the disease was treated by ligation of the vena cava and ovarian vein. Am J Obstet Gynecol 1970; 108(5): 681–7.
Guler S, Kokoglu OF, Ucmak H, Ozkan F. Postpartum ovarian vein thrombosis and renal vein thrombosis in a woman with protein S and C deficiency. Bmj Case Reports 2013.
Fiengo L, Bucci F, Patrizi G, Giannotti D, Redler A. Postpartum deep vein thrombosis and pulmonary embolism in twin pregnancy: undertaking of clinical symptoms leading to massive complications. Thromb J 2013; 11(1): 4.
Dhinakar M, Dhinakar L, Kamona A, Saifudeen A. Puerperal ovarian vein thrombosis presenting as rt loin pain and hydronephrosis: report of 2 cases. Oman Med J 2010; 25(4): 299–302.
Holmström SW, Barrow BP. Postpartum ovarian vein thrombosis causing severe hydronephrosis. Obstet Gynecol 2010; 115(2 Pt 2): 452–4.
Kolluru A, Lattupalli R, Kanwar M, Behera D, Kamalakannan D, Beeai MK. Postpartum ovarian vein thrombosis presenting as ureteral obstruction. Bmj Case Reports. 2010.
Brown CE, Stettler RW, Twickler D, Cunningham FG. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181(1): 143–8.
Angelini M, Barillari G, Londero AP, Bertozzi S, Bernardi S, Petri R, et al. Puerperal ovarian vein thrombosis: two case reports. J Thromb Thrombolysis 2013; 35(2): 286–9.
Carr S, Tefera G. Surgical treatment of ovarian vein thrombosis. Vasc Endovascular Surg 2006; 40(6): 505–8.
Thrombosis and embolism during pregnany and the puerperium. Reducing the risk. Green-top guideline no. 37a. Royal College of Obsetricians and Gynecologists; [cited 2013 Jul 8]. Available from: www.rcog.org.uk
Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik PO, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e691S–736S.
Mavri A, Vižintin Cuderman T, Štalc M, Božič M, Tratar G, Gubenšek M, et al. Priporočila za določanje testov trombofilije pri bolnikih z vensko trombozo. Zdr Vestn 2013; 82(2): 65–79.
Martinelli I, Battaglioli T, De Stefano V, Tormene D, Valdrè L, Grandone E, et al. The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A. J Thromb Haemost 2008; 6(3): 494–8.
Vavrinkova B, Binder T, Hadacova I, Hrachovinova I, Salaj P, Hruda M. Does asymptomatic carriage of FV Leiden and FII prothrombin mutations in heterozygous configuration pose an increased risk of thrombembolic complications in the course of pregnancy, labor and puerperium? Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov 2012 (in press).
Franchini M, Makris M. Non-O blood group: an important genetic risk factor for venous thromboembolism. Blood Transfus 2013; 11(2): 164–5.
Sode BF, Allin KH, Dahl M, Gyntelberg F, Nordestgaard BG. Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type. CMAJ 2013; 185(5):E229–237.
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