Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature

Ovarian vein thrombosis (OVT) is a rare but serious postpartum complication that, in most cases, occurs in the right ovarian vein. Certain diagnosis, following clinical suspect because of lower quadrant tenderness and fever that alone does not respond to adequate broad-spectrum antibiotics, is now based on computed tomography (CT), although other imaging techniques, such as color Doppler ultrasonography and magnetic resonance (MR) imaging, are useful. Heparin and intravenous antibiotics are the mainstay of treatment so as to avoid laparotomy. We report on the management of two cases of postpartum OVT.     

Renal vein thrombosis following puerperal ovarian vein thrombophlebitis

A case of renal vein thrombosis following puerperal ovarian vein thrombophlebitis is reported. We review the syndrome of puerperal ovarian vein thrombophlebitis and emphasize the potential for renal vein and vena caval involvement. The utility of computed tomographic scanning for diagnostic confirmation of this postpartum complication is described.     

Borderline ovarian tumors: an update

Borderline ovarian tumors account for 15-20% of all ovarian epithelial tumors and are diagnosed primarily in young women who want to preserve their childbearing potential. Due to the absence of specific preoperative criteria, diagnosis is often made during surgery or after the anatomopathologic examination. The management of borderline ovarian tumors with early stage is well-known and conservative surgery must be chosen as much as possible. Laparoscopic approach is possible for these tumors, allowing diagnosis, staging and also treatment. For advanced stage, laparotomy is still recommended. Staging must be performed during the initial surgery because tumor stage is one of the most relevant prognostic factors. Restaging operation should be discussed when complete staging was not made during initial surgery. Because his prognostic and therapeutic impacts are not proved, restaging surgery remains controversial. For that reason, it seems important to define clinical and histological criteria for patients with a high risk of upstaging.     

A case of septic ovarian vein thrombosis

Puerperal ovarian vein thrombosis commonly originates from purulent necrotic endomyometritis. The incidence is published to be 1 to 600 deliveries. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain, fever and leucocytosis. Discrepancy between the given clinical picture and the insignificant findings on gynaecologic examinations is common.     

Atypical ultrasonographic presentation of ovarian vein thrombosis

Ovarian vein trombosis (OVT) is a pathologic entity classically considered as a postpartum complication and only rarely associated with other diseases. Due to its vague symptoms, it is usually underdiagnosed. However its consequences can be fatal. We report a case of an incidental finding of ovarian thrombosis in an asymptomatic 45-year-old woman who underwent surgery due to the ultrasonographic finding of a para-ovarian cyst.     

Computed tomographic features of puerperal ovarian vein thrombosis

Puerperal ovarian vein thrombosis is a dangerous complication of childbirth and often leads to inferior vena cava thrombosis and multiple pulmonary emboli. Computed tomography of the abdomen is useful in early diagnosis. Two patients with typical computed tomographic features are presented.     

Internal jugular vein thrombosis following ovarian hyperstimulation syndrome

Two cases of women who developed internal jugular vein (IJV) thrombosis associated with ovarian hyperstimulation syndrome (OHSS) are reported in this article. There are 27 cases of IJV thrombosis associated with in vitro fertilisation (IVF) reported in the literature, and in 78% of cases, this outcome was following OHSS. The hypercoagulable state of OHSS increases the risk of venous thromboembolism, and the IJV appears to have a preponderance in uncommon-site thrombosis.     

Acute ovarian vein thrombosis in the third trimestre

BACKGROUND: Ovarian vein thrombosis is a known complication in the peri- and postpartum phase. Its incidence is documented as 1:600 to 1:2000. Concerning ovarian vein thrombosis in earlier stages of pregnancy there are only very few case reports. CASE REPORT: We report on a woman in her third pregnancy who presented with acute abdominal pain in the 27th week of gestation. After a long car drive she felt an acute pain in the upper right abdomen which moved down to the right lower abdomen. On admission the obstetrical examination showed no pathology. There were no contractions. Clinical and sonographic examination could not reveal the cause of the pain. As adequate analgesia failed to relieve the pain, an explorative laparotomy was performed. It showed a dilated right ovarian vein of 3 cm diameter with a thrombus reaching the confluence to the vena cava. The ovarian vessels were resected and the adnectomy on the right side performed. Anticoagulation was initiated. There were no complications during the postoperative course. The pregnancy proceeded normally. After 10 days the patient could be dismissed in good condition. Laboratory diagnostic showed an deficiency in protein C. At 39 weeks of gestation a planned caesarean section was performed without any complications.     

Computed tomography in diagnosis of puerperal ovarian vein thrombosis

The syndrome of puerperal ovarian vein thrombosis is often a diagnostic enigma. In the past, laparotomy has been the most frequent modality used to establish the diagnosis. The clinical picture and characteristic mass have not accurately predicted the presence of this syndrome, resulting in potentially dangerous and unnecessary surgery. The use of computed tomography is suggested as a noninvasive ancillary method.