• Anticoagulation
• Case report
• Deep vein thrombosis
• Ovarian vein thrombosis

Postpartum ovarian vein thrombophlebitis (POVT) is a rare but serious postpartum complication that affects mostly postpartum women. A high index of suspicion is required when faced with sudden postpartum abdominal pain.

A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever (temperature 39.6℃) one day after delivery, accompanied with left lower abdominal pain. Physical examination indicated mild tenderness in the left lower abdomen, accompanied with rebound pain. The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multi-detector row computed tomography scan.

POVT is a rare and dangerous postpartum complication. A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever. Early application of Doppler ultrasound, computed tomography, magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT, thus reducing maternal mortality.

• Ovarian venous thrombosis
• Postpartum
• Multi-detector row computed tomography
• Case report

Ovarian vein thrombosis (OVT) is an uncommon condition, occurring in ~1 in every 600–2,000 pregnancies. It is associated with various conditions, including thrombophilia, malignancy, sepsis, intra-abdominal and pelvic inflammatory conditions, pregnancy, and the postpartum period, and specific surgical interventions, particularly gynecological surgeries. Thus, this study aims to identify the associated factors for OVT and elaborate on the standard treatment strategies for its management.

Retrospective data collection was used. Our study consists of 18 patients diagnosed with OVT between 2005 and 2016; the data was collected from the Health Information Management system at King Fahad Medical City, Riyadh, Saudi Arabia using a standard format.

Our study found that OVT involves the right ovarian vein more often than the left and mainly occurs in women during their postpartum period. These patients other associated factor included hypertension, diabetes, and a higher body mass index (BMI) of above 25 kg/m². The most frequently presenting complaints were abdominal pain and fever. The most common treatment was the administration of enoxaparin (a low molecular weight heparin) for an average duration of one to three months, which resulted in a low recurrence rate of OVT.

Physicians should be vigilant for suspicion of OVT in female patients presenting with lower abdominal pain and fever in their postpartum period. Additionally, it is suggested to use low molecular weight heparin as initial therapy for OVT for one to three months, resulting in a high remission rate.

• Idiopathic ovarian vein thrombosis
• abdominal pain
• pelvis
• postpartum period
• pulmonary embolism
• rivaroxaban
• thrombus

• Abdominal Pain
• Adult
• Female
• Humans
• Ovary/diagnostic imaging
• Pulmonary Embolism/diagnostic imaging
• Pulmonary Embolism/etiology
• Tomography, X-Ray Computed
• Venous Thrombosis/diagnostic imaging

• haematology (incl blood transfusion)
• obstetrics and gynaecology

• Adult
• Anticoagulants/therapeutic use
• Female
• Humans
• Ovary/diagnostic imaging
• Thrombosis
• Vena Cava, Inferior
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/drug therapy
• Warfarin/therapeutic use

Ovarian vein thrombosis (OVT) is a potentially life-threatening condition, and it is typically related to the peripartum period; however, it is also associated with pelvic inflammatory disease, recent pelvic or abdominal surgery, inflammatory bowel disease, thrombophilia, malignancy, and sepsis. Idiopathic isolated OVT is rare and is usually presented as case reports in the medical literature. In this report, we present a case of bilateral OVT in a postmenopausal female with no identifiable risk factors and normal coagulation profile workup to highlight the importance of considering it as a differential diagnosis in female patients presenting with abdominal pain. Early identification can prevent potentially life-threatening complications. Management is often conservative, and the choice of anticoagulation is based on the patient’s medical conditions. In this particular scenario, the patient was managed with low molecular weight heparin (LMWH) and transitioned to direct oral anticoagulant (DOAC) before discharge.

• bilateral thrombosis
• idiopathic ovarian vein thrombosis
• ovarian vein thrombosis

Septic pelvic thrombophlebitis is a rare puerperal complication. It is an important differential diagnosis of postpartum fever and abdominal pain and although the condition is well known its diagnosis can be challenging. We report a case of a 41-year-old woman with fever and right abdominal pain three days after an uncomplicated caesarean delivery. Clinical, laboratory and imaging exams were unremarkable and the patient was treated for endometritis. In the absence of improvement despite an antibiotic adjustment, a clinical diagnosis of septic pelvic thrombophlebitis was made, and the patient presented a good response to anticoagulation in conjunction with broad-spectrum antibiotic therapy.

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Caesarean delivery is a risk factor for septic pelvic thrombophlebitis (SPT).

• Abdominal pain
• Caesarean section
• Fever
• Pelvic septic thrombophlebitis
• Postpartum period

Ovarian vein thrombosis (OVT) is an extremely rare but life-threatening complication of the postpartum period. It has never been reported as a complication of laparoscopic surgery. We report a case of right ovarian vein thrombosis that occurred in the postoperative period after patient underwent laparoscopic salpingectomy for a right side ectopic pregnancy. She presented with 1-week history of abdominal pain and fever. A complete workup for fever was performed and was found negative. Computed tomography of the abdomen and pelvis revealed right ovarian vein thrombosis. The patient was treated with anticoagulant therapy and responded well.

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.

• Abdominal Pain
• Infection
• Pelvis
• Thrombophlebitis
• Venous Thrombosis

• Contrast Media
• Female
• Humans
• Image Enhancement/methods
• Magnetic Resonance Imaging/methods
• Ovary/blood supply
• Ovary/diagnostic imaging
• Tomography, X-Ray Computed/methods
• Ultrasonography/methods
• Venous Thrombosis/diagnosis
• Venous Thrombosis/drug therapy