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Barrios-López M, Sánchez-Bernal S, Julián Gómez E, Galante MJ, Herrán de la Gala D, González-Sánchez FJ, Fernández-Flórez A, Barba-Arce A, González-Carreró C. Postpartum obstetric complications: a guide for radiologists. Abdom Radiol (NY) 2024:10.1007/s00261-024-04445-y. [PMID: 39088017 DOI: 10.1007/s00261-024-04445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 08/02/2024]
Abstract
The puerperium refers to the 6-8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key.
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Affiliation(s)
- Marta Barrios-López
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain.
| | - Sara Sánchez-Bernal
- Department of Radiology, Hospital Clínico Universitario de Salamanca, P San Vicente 182, 37007, Salamanca, Spain
| | - Elena Julián Gómez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - María José Galante
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Darío Herrán de la Gala
- Department of Radiology, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | | | - Alejandro Fernández-Flórez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Ana Barba-Arce
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Carmen González-Carreró
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
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2
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Rao K, Aswani Y, Bindner H, Patel A, Averill S, Davis T, Amarneh M. Intra-abdominal Venous Thromboses and Their Management. Acad Radiol 2024; 31:3212-3222. [PMID: 38184416 DOI: 10.1016/j.acra.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
While a plethora of articles discuss management of deep venous thromboses in extremities, there is a relative scarcity of literature comprehensively describing intra-abdominal venous thromboses, and their management. Intra-abdominal venous thromboses include iliocaval venous obstruction (ICVO), hepatic venous thrombosis (HVT), portal venous thrombosis (PVT), renal vein thrombosis (RVT), splenic vein thrombosis (SVT), and gonadal vein thrombosis (GVT); each of which provides unique microenvironmental challenges to management. Doppler ultrasound is the first line imaging modality for diagnosis, and computed tomography and magnetic resonance imaging can help define the extent of thrombus burden and aid with interventional planning. Systemic anticoagulation remains the common medical treatment for intra-abdominal venous thrombosis, however, catheter directed thrombolysis and thrombectomy show positive outcomes in ICVO, HVT, PVT, and RVT, with transjugular intrahepatic portosystemic shunt (TIPS) creation especially beneficial in HVT and PVT. In this review article, we describe pathophysiology, clinical features, imaging findings, and current management options for intra-abdominal venous thromboses.
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Affiliation(s)
- Karan Rao
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Yashant Aswani
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Hans Bindner
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Aditi Patel
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Sarah Averill
- Roswell Park Comprehensive Cancer Institute, Buffalo, New York, USA (S.A.)
| | - Trent Davis
- Dignity Health St. Joseph's Radiology, Phoenix, Arizona, USA (T.D.)
| | - Mohammad Amarneh
- Department of Pediatric Interventional Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, Massachusetts 02115, USA (M.A.).
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3
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El-Diasty MT, Noorelahi Y. Imaging Findings of Ovarian Vein Thrombosis. Cureus 2023; 15:e48672. [PMID: 38024035 PMCID: PMC10640670 DOI: 10.7759/cureus.48672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
Ovarian vein thrombosis (OVT) is an uncommon condition that occurs mainly in the peripartum period. Hyper-coagulable conditions have been reported to cause OVT outside the peripartum period. The clinical presentation is usually nonspecific pain, but it can be asymptomatic in patients with underlying malignancy. Imaging plays an important role in diagnosis. Ultrasound is the initial imaging modality, but it is operator-dependent and has limited sensitivity. Computed tomography (CT) is the most commonly used modality for diagnosis. CT can show the luminal filling defect within the thrombosed vein and assess the extension of the thrombosis. MRI can show the thrombosed vein as a filling defect on post-contrast images; also, diffusion-weighted images may help in the diagnosis. Complications include extension into the inferior vena cava or renal veins. Pulmonary embolism is the most serious complication. Treatment includes anticoagulation plus antibiotics. Early diagnosis is essential to prevent complications.
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Affiliation(s)
| | - Yasser Noorelahi
- Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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4
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Masselli G, Bonito G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications. Diagnostics (Basel) 2023; 13:2909. [PMID: 37761275 PMCID: PMC10528125 DOI: 10.3390/diagnostics13182909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient's body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.
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Affiliation(s)
- Gabriele Masselli
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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5
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Gao Q, Xiong J, Jiang H. Pharmacologic treatment of a postpartum ovarian vein thrombosis: Case report. Medicine (Baltimore) 2023; 102:e34711. [PMID: 37565858 PMCID: PMC10419415 DOI: 10.1097/md.0000000000034711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Postpartum ovarian vein thrombosis (POVT) is a rare disease, and could cause severe complications if ignored. We report a case of POVT, including the patient clinical features, diagnostic methods, treatment, and follow-up results. CASE PRESENTATION A 30-year-old Asian woman was admitted to our hospital because of spontaneous abortion. After the miscarriage, she presented with fever and right lower abdominal pain. A physical examination revealed abdominal tenderness in the right lower quadrant with a palpable mass. Laboratory tests showed leucocytosis and elevated C-reactive protein. Abdominal ultrasound (US) and computed tomography revealed right ovarian vein thrombosis (OVT). The patient was treated with systemic anticoagulation and antibiotics and was discharged 22 days later on a regimen of an oral anticoagulant. 1.5 months after discharge, an US with a color Doppler examination showed no OVT. CONCLUSION A high index of suspicion is required in cases of abdominal pain and fever after delivery, especially if unresponsive to antibiotics. It should be differentiated from acute appendicitis, accessory abscess, endometritis, ovarian torsion, and other acute abdominal diseases. For a POVT case with a definite diagnosis, drug treatment may be effective enough.
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Affiliation(s)
- Qianqian Gao
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Jinqiu Xiong
- Departments of General Surgery, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Hong Jiang
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
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Takahashi Y, Matsubara S, Tamura K, Koyanagi T, Yoshiba T, Takahashi S, Taneichi A, Takei Y, Saga Y, Fujiwara H. Ovarian vein thrombosis after bilateral adnexectomy in a symptomatic patient with concomitant pulmonary embolism: A case report. Taiwan J Obstet Gynecol 2023; 62:559-561. [PMID: 37407194 DOI: 10.1016/j.tjog.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Ovarian vein thrombosis (OVT) after adnexectomy is usually asymptomatic, and pulmonary embolism (PE) has not been reported following this type of OVT. We present the case of a patient with symptomatic OVT after bilateral adnexectomy who experienced PE. CASE REPORT A 52-year-old woman underwent total laparoscopic hysterectomy and bilateral adnexectomy for early stage endometrial cancer. On the 12th postoperative day, she presented with a fever of 38.7 °C. Computed tomography (CT) revealed bilateral OVT. Anticoagulant and antibacterial therapy was initiated; after five days, the fever subsided. On the 19th postoperative day, CT revealed a decrement in OVT; however, PE was observed. By the 60th postoperative day, PE disappeared. No deep vein thromboses were detected at any time. CONCLUSION This case highlights that OVT, even after adnexectomy, can cause symptoms and PE can occur after this type of OVT. Anticoagulation therapy may be considered in such cases.
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Affiliation(s)
- Yoshifumi Takahashi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan; Department of Obstetrics and Gynecology, Koga Red Hospital, 1150 Shimoyama, Koga, Ibaraki 306-0014, Japan
| | - Kohei Tamura
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Takahiro Koyanagi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Takahiro Yoshiba
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Suzuyo Takahashi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Yasushi Saga
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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7
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Beyazıt A, Soylu Karapınar O, Dolapçıoğlu KS, Beyazıt S. Postpartum Ovarian Vein Thrombosis Due to COVID-19 in Pregnancy: A Case Report. Cureus 2023; 15:e36267. [PMID: 37073181 PMCID: PMC10105822 DOI: 10.7759/cureus.36267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Ovarian vein thrombosis is a clinic condition that is generally seen in the postpartum period and can mimic acute appendicitis with acute abdomen. The incidence of occurrence has increased further in cases predisposing to thrombosis. Coronavirus disease 2019 (COVID-19) during pregnancy causes increased thromboembolic events. Here we examined a case of ovarian vein thrombosis after stopping enoxoparin in a postpartum patient who had COVID-19 during pregnancy.
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8
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Magnetic Resonance Imaging of Acute Adnexal Pathology. Magn Reson Imaging Clin N Am 2023; 31:109-120. [DOI: 10.1016/j.mric.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Knox T, Patel S. Ovarian vein thrombosis: A rare cause of abdominal pain as a complication of an elective abortion. Am J Emerg Med 2023; 63:177.e5-177.e6. [PMID: 36253215 DOI: 10.1016/j.ajem.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare diagnosis. Patients can appear to be very uncomfortable on presentation with a physical examination that can mimic an acute abdomen. OVT is most often diagnosed during the postpartum period [Jenayah et al., 2015] and not typically seen during pregnancy or after procedures such as dilation and curettage (D&C). The complications from an OVT are significant and include sepsis, thrombophlebitis and pulmonary embolism [Harris et al., 2012]. Here we describe a case of OVT with an atypical presentation, diagnosed twenty-four hours after an elective D&C for a second trimester abortion.
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Affiliation(s)
- Tara Knox
- PGY-2 Emergency Medicine Resident, Cooper Medical School of Rowan University, USA.
| | - Sundip Patel
- Emergency Medicine, Cooper Medical School of Rowan University, USA.
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10
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Markus J, van der Weiden RM. Laparoscopic diagnosis of idiopathic left ovarian vein thrombosis in a 27-year-old woman. JRSM Open 2022; 13:20542704221074150. [PMID: 35096407 PMCID: PMC8793118 DOI: 10.1177/20542704221074150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Idiopathic left ovarian vein thrombosis was diagnosed in a 27-year-old woman at the time of a diagnostic laparoscopy performed because of a suspected ovarian torsion. The diagnosis was confirmed by abdominal computed tomography scanning. Subsequent magnetic resonance imaging showed no signs of an abdominal or pelvic mass nor enlarged lymph nodes. The patient was treated with systemic anticoagulation therapy for 3 months and made a good recovery. During follow-up it became clear that the patient was already diagnosed with familial hypercholesterolemia before the occurrence of the ovarian vein thrombosis. It remains unclear if familial hypercholesterolemia played a role in the occurrence of ovarian vein thrombosis in our patient.
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Affiliation(s)
- Jasper Markus
- Franciscus Gasthuis & Vlietland, Department of Gynecology & Obstetrics, Rotterdam, Netherlands
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11
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Martins MM, Carneiro C, Leitão S, Costa C. Ovarian vein thrombosis: a rare but not to be forgotten cause of abdominal pain. BMJ Case Rep 2021; 14:e246542. [PMID: 34969801 PMCID: PMC8719155 DOI: 10.1136/bcr-2021-246542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/04/2022] Open
Abstract
A healthy 38-year-old woman, with no significant medical or surgical history, was referred to the gynaecology emergency department with acute low quadrant abdominal pain and nausea. On examination, painful palpation of right iliac fossa, abdominal guarding and positive Blumberg's sign were noted. An abdominal-pelvic CT scan showed a hypodense tubular structure with peripheral enhancement to the right of the inferior vena cava, suggestive of thrombosis of the right ovarian vein. The only risk factor identified was the use of the combined contraceptive pill.
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Affiliation(s)
- Matilde Matos Martins
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
| | - Carolina Carneiro
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
| | - Susana Leitão
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
| | - Cristina Costa
- Gynaecology and Obstetrics, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
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12
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Tsitlakidis C, Al Ajmi KIS, Al Madhani AY, Ahmidat AH. Postpartum ovarian vein thrombosis manifesting as acute appendicitis: a case report. J Med Case Rep 2021; 15:521. [PMID: 34689824 PMCID: PMC8543884 DOI: 10.1186/s13256-021-03102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/06/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Postpartum ovarian thrombosis is an uncommon condition. It appears with the nonspecific, predominantly right-sided abdominal symptoms and must be differentiated from other acute visceral conditions. If left untreated, postpartum ovarian thrombosis can have severe consequences, including sepsis, pulmonary embolism, and even death. Momentarily, there are no specific guidelines for postpartum ovarian thrombosis management. We present a case of postpartum ovarian thrombosis admitted to our hospital with symptoms of acute appendicitis. CASE PRESENTATION : A 39-year-old Omani obese multiparous woman of Afro-Arab origin was admitted with acute symptoms, mainly abdominal pain, fever, and vomiting 1 week postpartum. Clinical picture and biochemical profile did not exhibit a recognizable pattern. Ultrasonography excluded retained products of conception. Computerized scan for abdomen and pelvis with oral and intravenous contrast reported a dilated tubular structure in the right adnexa extending up to the right renal hilum level with surrounding inflammation. Those findings were consistent with the thrombophlebitis of the right ovarian vein. Blood cultures and sensitivity showed group A β-hemolytic streptococci sensitive to penicillin G and clindamycin. The patient was treated successfully with antibiotics and therapeutic anticoagulants and discharged home 3 days later; follow-up was arranged. CONCLUSION This pathology is an exceptional entity in Oman. Therefore, awareness of this unique condition is required so that clinicians will be vigilant, exploring similar cases with imaging and avoiding unnecessary surgical interventions.
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13
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Glanzer R, Rogers N, Patrick RJ, Hassebroek-Johnson J. Diagnostic laparoscopy and oophorectomy for ovarian vein thrombosis in a patient with COVID-19: a surgical case report and literature review. J Surg Case Rep 2021; 2021:rjab389. [PMID: 34512948 PMCID: PMC8427704 DOI: 10.1093/jscr/rjab389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare condition most frequently associated with pelvic inflammatory disease (PID), malignancy or the immediate postpartum period. This case study reports on a 56-year-old woman who developed OVT 11 days after a positive COVID-19 diagnosis. Imaging including abdominal/pelvic computed tomography, transvaginal Doppler ultrasound and transabdominal pelvic ultrasound failed to definitively diagnose the thrombotic etiology of the patient's presentation. Ultimately, laparoscopic visualization and subsequent oophorectomy were necessary for diagnostic and therapeutic purposes. The patient did not have underlying malignancy, recent surgical history, history of PID or any history of previous thromboembolic events. Therefore, this report contributes further evidence to the growing knowledge of systemic manifestations associated with COVID-19 that may require surgical intervention.
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Affiliation(s)
| | - Nicole Rogers
- Sanford School of Medicine, Vermillion, SD 57069, USA
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14
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Takahashi Y, Takei Y, Taneichi A, Takahashi S, Yoshiba T, Koyanagi T, Saga Y, Fujiwara H. Ovarian vein thrombosis after gynecological malignant tumor surgery with adnexectomy: Clinical features and outcomes. Thromb Res 2021; 203:90-92. [PMID: 33989983 DOI: 10.1016/j.thromres.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Yoshifumi Takahashi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan; Department of Gynecology, Tochigi Cancer Center, Utsunomiya, Japan.
| | - Yuji Takei
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Suzuyo Takahashi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Yoshiba
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Koyanagi
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yasushi Saga
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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15
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Riva N, Ageno W. Direct oral anticoagulants for unusual-site venous thromboembolism. Res Pract Thromb Haemost 2021; 5:265-277. [PMID: 33733025 PMCID: PMC7938617 DOI: 10.1002/rth2.12480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half-life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual-site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual-site VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
| | - Walter Ageno
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
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16
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Abstract
Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70-80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Yapar Eyi EG, Halıcı Öztürk F, Alkan M. Placenta percreta-induced uterine rupture with right ovarian vein thrombus protracting into the inferior vena cava. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:493-497. [PMID: 32783208 DOI: 10.1002/jcu.22903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
In Turkey, the triad of prior cesarean section (CS), placenta previa, and placenta accreta spectrum is worth of concern. Here, we present an unpublished complication of placenta percreta-induced uterine rupture: ovarian vein thrombosis (OVT) protracting into the inferior vena cava (IVC) in a woman with a previous CS and placenta previa. We propose the integration of the sub-xiphoid transabdominal long axis of the IVC into the point-of-care ultrasound practice with color Doppler to establish the diagnosis of complicated OVT. To prevent placenta accreta spectrum-related complications, there is an urgent need to lower CS rate both globally and in Turkey.
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Affiliation(s)
| | | | - Mihriban Alkan
- Ministry of Health Ankara City Hospital, Bilkent, Ankara, 06800, Turkey
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19
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Glackin P, Crabo LG. A Case of Postpartum Thrombophlebitis of a Retroperitoneal Varix Mimicking Acute Appendicitis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319848744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of thrombophlebitis of a retroperitoneal varix in a postpartum patient with right lower quadrant pain is presented. The sonographic examination was falsely positive for appendicitis, but the correct diagnosis was made with a subsequent computed tomogram. The thrombosed varix was likely a collateral of the right ovarian vein, analogous to postpartum ovarian vein thrombophlebitis (POVT), an uncommon potentially fatal disorder. POVT is reviewed, emphasizing features useful for distinguishing it from appendicitis at sonography. Sonographers should be aware of the possibility of thrombophlebitis when examining postpartum patients with right lower quadrant pain.
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Affiliation(s)
- Paula Glackin
- Imaging Department, PeaceHealth Saint Joseph Medical Center, Bellingham, WA, USA
| | - Lars G. Crabo
- Imaging Department, PeaceHealth Saint Joseph Medical Center, Bellingham, WA, USA
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Abrantes J, Teixeira E, Gomes F, Fernandes C. Postpartum ovarian vein thrombosis and venous anatomical variation. BMJ Case Rep 2019; 12:12/6/e228399. [PMID: 31229971 DOI: 10.1136/bcr-2018-228399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 34-year-old multipara presented 72 hours postpartum with acute right-sided abdominal pain. The investigation revealed mild leucocytosis with positive D-dimer and elevated C reactive protein. Abdominal ultrasound and abdominopelvic CT demonstrated an enlarged right ovarian vein with endoluminal thrombus, representing postpartum ovarian vein thrombosis. The patient became asymptomatic 48 hours after starting broad-spectrum antibiotic treatment and anticoagulant therapy. She completed the treatment in ambulatory regimen and control abdominopelvic CT imaging was performed and revealed a duplicated right ovarian vein and a small residual subacute thrombus in the lumen of the distal right ovarian vein. The patient remained asymptomatic in the clinical follow-up.
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Affiliation(s)
- João Abrantes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | | | - Fernanda Gomes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
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Abstract
A fenestration in the left ovarian vein was found in a fresh-frozen female cadaver. The opening did not have any vessels or additional anatomical structures passing through it. The ovarian vein is also referred to as the female gonadal vein. This type of anatomical variation is clinically relevant in procedures that deal with the manipulation of the gonadal veins, specifically conditions such as ovarian vein thrombosis, ovarian vein stenosis, and pelvic congestion syndrome.
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Affiliation(s)
- Mayank Patel
- Clinical Anatomy Research, Seattle Science Foundation
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22
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Al-Αchmar SN, Stavrou S, Protopapas A, Drakakis P, Siemou P, Chatzipapas I. Ovarian vein thrombosis after total laparoscopic hysterectomy with unilateral adnexectomy: A case report. Int J Surg Case Rep 2017; 41:1-4. [PMID: 29017137 PMCID: PMC5633753 DOI: 10.1016/j.ijscr.2017.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 12/02/2022] Open
Abstract
Symptoms are often not specific and may include fever, abdominal pain, flank and back pain. Treatment is controversial and there is no standard evidence – based protocol; anticoagulation therapy and antibiotics remain the main basic therapy. The application of bipolar electrocautery and the pexy of the ovary are possible contributing mechanisms for the thrombus formation.
Introduction Ovarian vein thrombosis is a rare but potentially serious complication after surgical and gynecologic procedures such as oophorectomy and hysterectomy. The association of this event with laparoscopic hysterectomy in particular, is very rare. Only two cases have been described so far. Presentation of case We present a case of ovarian vein thrombosis after laparoscopic hysterectomy in a 40-year-old with deep endometriosis and multiple intramural uterine myomas. Laparoscopic hysterectomy, left oophorectomy, right salpingectomy, and suspension (ovariopexy) of the right ovary on the ipsilateral round ligament of the uterus were performed, using bipolar electrocautery as a hemostatic tool. Discussion The 7th postoperative day the patient presented to our hospital complaining of abdominal pain and fever. An abdominal CT scan demonstrated a filling defect and enlargement of the right ovarian vein, a finding compatible with ovarian vein thrombosis. She was treated with low molecular weight heparin (LMWH). On the 19th postoperative day, an MRI scan was performed and did not reveal any pathological findings of the right ovarian vein. The patient was discharged on LMWH for three months. Post treatment evaluation for thrombophilia was negative for pathological findings. Conclusion Our case is a very rare condition. Only two ‘similar’ cases have been described in the literature so far. Bipolar electrocautery and ovariopexy on the ipsilateral round ligament during laparoscopic hysterectomy should be evaluated further as possible contributing mechanisms for the thrombus formation.
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Affiliation(s)
- Samer Nikolaos Al-Αchmar
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
| | - Sofoklis Stavrou
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
| | - Athanasios Protopapas
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
| | - Peter Drakakis
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
| | - Panagiota Siemou
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
| | - Ioannis Chatzipapas
- 1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
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Fernández Rial M, Pardo Pumar M, Ouviña Millán O, Cumbraos Alvarez J, Moral Santamarina E. Trombosis de la vena ovárica: casuística en 5 años y revisión de la literatura. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Genital and gynecologic infections are common medical problems, affecting millions of women worldwide. The spectrum of these infections extends from the labia, including processes such as necrotizing fasciitis and anogenital warts, to the upper reproductive tracts in conditions including endometritis and pelvic inflammatory disease. Although often a clinical diagnosis, the radiologist plays an important role in determining the etiology of acute abdominal and pelvic pain as well as facilitating the diagnosis for cases which are not clinically straightforward. Imaging also plays an important role in assessing the complications and sequelae of these conditions, including infertility, chronic abdominal and pelvic pain, and pelvic adhesions. Familiarity with the appearances of these infections, their complications, and their potential mimics on sonography, computed tomography, magnetic resonance imaging, and hysterosalpingography is important for timely diagnosis and optimal clinical outcomes.
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Rottenstreich A, Da'as N, Kleinstern G, Spectre G, Amsalem H, Kalish Y. Pregnancy and non-pregnancy related ovarian vein thrombosis: Clinical course and outcome. Thromb Res 2016; 146:84-88. [PMID: 27614189 DOI: 10.1016/j.thromres.2016.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To collect and summarize demographic, clinical, laboratory and radiologic characteristics, as well as management and follow-up data, of patients diagnosed with ovarian vein thrombosis. METHODS A multicenter retrospective review of all patients diagnosed with ovarian vein thrombosis between January 2000 and May 2015 at three university hospitals. RESULTS Data of 74 women were analyzed. Mean age was 31±9years. Sixty (81.1%) cases were pregnancy-related. The presence of at least one underlying risk factor (most commonly active infection or surgery) was more common among pregnancy than non-pregnancy related cases (61.7% vs. 14.3%, P=0.002). Anticoagulation therapy was administered in 98.6% of patients and adjunctive antibiotic therapy in 39 (52.7%). At a median follow-up of 40±38months, only one recurrent thrombotic event was observed, and no events of death. Median duration of anticoagulation treatment tended to be longer among patients with non-pregnancy related OVT (6months [3-14] vs. 3months [3-6], P=0.1). Thrombophilic evaluation detected any thrombophilic risk factor in 12 (20%) and 6 (42.9%) women with pregnancy and non-pregnancy related ovarian vein thrombosis, respectively (P=0.09). CONCLUSION Pregnancy-related ovarian vein thrombosis is characterized by a provoked nature and a high rate of resolution after short term treatment. Treatment of three months duration of anticoagulation following this condition appeared in this study to be safe, with no recurrences encountered during a median follow up of 40months. Thrombophilia seems to have an important role in ovarian vein thrombosis and should be evaluated in non-pregnancy related cases.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nael Da'as
- Internal Medicine D, Hematology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Geffen Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel
| | - Galia Spectre
- Department of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Takeda A, Yamase Y, Koike W, Hayashi S, Imoto S, Nakamura H. Pulmonary thromboembolism as a result of ovarian vein thrombosis after laparoscopic-assisted vaginal hysterectomy for uterine myoma. J Obstet Gynaecol Res 2016; 42:743-747. [DOI: 10.1111/jog.12973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/23/2015] [Accepted: 01/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Takeda
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - Y. Yamase
- Department of Cardiovascular Medicine; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - W. Koike
- Department of Diagnostic Radiology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - S. Hayashi
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - S. Imoto
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - H. Nakamura
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
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Lerouge J, Sanguin S, Gondry J, Sergent F. Prise en charge de la thrombose veineuse ovarienne du post-partum. L’expérience du CHU d’Amiens. ACTA ACUST UNITED AC 2016; 44:88-95. [DOI: 10.1016/j.gyobfe.2015.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
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Mantha S, Sarasohn D, Ma W, Devlin SM, Chi DS, Roche KL, Suidan RS, Woo K, Soff GA. Ovarian vein thrombosis after debulking surgery for ovarian cancer: epidemiology and clinical significance. Am J Obstet Gynecol 2015; 213:208.e1-4. [PMID: 25743130 DOI: 10.1016/j.ajog.2015.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/05/2015] [Accepted: 02/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ovarian vein thrombosis is associated with pregnancy and pelvic surgery. Postpartum ovarian vein thrombosis is associated with infection and a high morbidity rate and is treated with anticoagulant and intravenous antibiotic therapy. The natural history of such thrombotic events after debulking surgery for ovarian cancer has not been well described. Our objective was to characterize the presentation and outcomes for patients with this condition at our institution. STUDY DESIGN We conducted a retrospective study of patients who underwent surgical debulking for ovarian cancer at Memorial Sloan Kettering Cancer Center between the years 2001 and 2010. Patients were included if contrast computed tomography scans of both the abdomen and pelvis were performed within 12 weeks before and 12 weeks after the surgery. The images were reviewed to assess for the presence and extent of a new postoperative ovarian vein thrombosis. When available, subsequent studies were assessed for thrombus progression. Medical records were reviewed to determine whether anticoagulation was used for treatment of the thrombotic episode and to record the occurrence of any new significant venous thromboembolic event in the next year. RESULTS One hundred fifty-nine patients had satisfactory imaging. New ovarian vein thrombosis was a common complication of debulking surgery, as found in 41 of patients (25.8%). Only 5 women with ovarian vein thrombosis were started on anticoagulation, of which 2 individuals had an independent venous thromboembolic event as indication for treatment. Only 2 of the ovarian vein thromboses (4.9%) progressed to the inferior vena cava or left renal vein on subsequent scan. The estimated cumulative incidence of venous thromboembolism 1 year after the first postoperative scan was 17.1% for patients in the new ovarian vein thrombosis group vs 15.3% of individuals for the group without a postoperative ovarian vein thrombosis (P = .78). CONCLUSION Ovarian vein thrombosis is commonly encountered after debulking surgery for ovarian cancer. Anticoagulation is usually not indicated, and clinically meaningful thrombus progression rarely occurs.
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Mone F, McKeown G, Adams B. Ovarian vein thrombosis in pregnancy and the puerperium – A case series. J OBSTET GYNAECOL 2015; 35:853-4. [DOI: 10.3109/01443615.2015.1009420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Karrasch M, Rödel J, Mühler N, Edel B, Sachse S, Schmidt KH, Schneider U, Schlembach D, Mentzel HJ, Pfister W, Schleußner E. Ovarian vein thrombosis (OVT) following invasive group A Streptococcus (iGAS) puerperal sepsis associated with expression of streptococcal pyrogenic exotoxin genes speC, speG and speJ. Eur J Obstet Gynecol Reprod Biol 2015; 184:127-30. [DOI: 10.1016/j.ejogrb.2014.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/24/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
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Bhandari HM, Jeevan D, Slinn J, Goswami K. Postpartum ovarian vein thrombosis in a 29-year-old woman with ulcerative colitis. BMJ Case Rep 2014; 2014:bcr2014206452. [PMID: 25471109 PMCID: PMC4256663 DOI: 10.1136/bcr-2014-206452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old woman with known ulcerative colitis developed a right-sided abdominal pain a day after preterm vaginal delivery at 30 weeks. She did not have any nausea, vomiting and had normal bowel movements. The observations were within normal limits and white cell counts were marginally elevated with a normal C reactive protein. A large ovarian vein thrombosis on the left side was an incidental finding on a CT of the abdomen and pelvis undertaken to establish the cause for abdominal pain. The patient was managed by a multidisciplinary team and was treated with anticoagulants for 6 months. This case illustrates that the incidence of pelvic venous thrombosis may be higher in pregnancy and puerperium.
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Affiliation(s)
- Harish M Bhandari
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - David Jeevan
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jessica Slinn
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kavita Goswami
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
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Total right ovarian vein thrombosis after cesarean section. J Emerg Med 2014; 48:e25-7. [PMID: 25440864 DOI: 10.1016/j.jemermed.2014.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/17/2014] [Accepted: 09/02/2014] [Indexed: 11/23/2022]
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Roepke RML, de Campos FPF, Lovisolo SM, Santos EHS. Septic pelvic thrombophlebitis of unknown origin: an ever threatening entity. AUTOPSY AND CASE REPORTS 2014; 4:39-46. [PMID: 28573117 PMCID: PMC5444397 DOI: 10.4322/acr.2014.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022] Open
Abstract
Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are non-specific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broad-spectrum antibiotic regimen in these cases.
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Affiliation(s)
- Roberta Muriel Longo Roepke
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Silvana Maria Lovisolo
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Cook RM, Rondina MT, Horton DJ. Rivaroxaban for the Long-term Treatment of Spontaneous Ovarian Vein Thrombosis Caused by Factor V Leiden Homozygosity. Ann Pharmacother 2014; 48:1055-1060. [PMID: 24798316 DOI: 10.1177/1060028014533304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report a case where rivaroxaban was used in the management of an ovarian vein thrombosis and to briefly review the literature, pathophysiology, and clinical implications therein. CASE SUMMARY A 30-year-old previously healthy woman was diagnosed with acute, spontaneous, left-ovarian vein thrombosis (OVT) with proximal extension into the renal vein. After initial catheter-directed thrombolysis with tPA, angioplasty of the left renal vein, and heparinoid treatment, rivaroxaban was begun for long-term anticoagulation. Three months after her index event she was symptom free, with complete resolution of her thrombosis and no adverse effects or bleeding complications from rivaroxaban. To our knowledge, this is the first report of OVT successfully treated with rivaroxaban. DISCUSSION OVT is a rare but potentially fatal cause of abdominal pain that may pose diagnostic and therapeutic dilemmas. Factor V Leiden (FVL) homozygosity, an uncommon but severe inherited thrombophilia, increases the risk of thrombosis by approximately 50- to 80-fold. This case report and accompanying literature review highlight important clinical pearls related to the diagnosis and management of OVT and inherited thrombophilias. CONCLUSIONS This clinical vignette adds to the published literature suggesting that novel oral anticoagulants, such as rivaroxaban, may eventually emerge as an alternative to vitamin K antagonists for the treatment of extra-axial thromboses. Reporting these cases is important because their prevalence is low outside of specialized referral centers, and thus, dissemination of these experiences may help other providers in treating their patients.
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Affiliation(s)
- Rhett M Cook
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | | | - Devin J Horton
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Holmsen Fairchild A, Beecham Chick JF, Dorton BJ. Identity crisis: the patient's abdominal discomfort stemmed from a treacherous event. Am J Obstet Gynecol 2013; 209:70.e1-2. [PMID: 23454252 DOI: 10.1016/j.ajog.2013.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/29/2012] [Accepted: 02/24/2013] [Indexed: 11/18/2022]
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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 Rep 2013; 2013:bcr-2013-009164. [PMID: 23696144 DOI: 10.1136/bcr-2013-009164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Selma Guler
- Department of Infectious Disease, Faculty of Medicine, Kahramanmaras, Turkey.
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