Postpartum Ovarian Vein Thrombosis: Incidental Diagnosis at Surgery

Ovarian vein thrombosis is a rare clinical entity that may present in the puerperium. We report the clinical outcomes of two cases of postpartum ovarian vein thrombosis, incidentally diagnosed at laparotomy in 16-year-old and 23-year-old females. They had preoperative diagnosis of torsion tuboovarian mass and twisted pedunculated uterine fibroid, respectively. Both patients had transection and ligation of right thrombosed ovarian vein. Postoperative management included a week course of anticoagulant, antibiotics and analgesia. Postpartum ovarian vein thrombosis is a diagnosis of exclusion in the puerperium and a high index of suspicion will reduce associated morbidity and mortality. 1. Introduction Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication, with an incidence of 1/600 and 1/2000 deliveries [1]. Its occurrence in nonpregnant patients has seldom been reported [2]. Three factors important in the pathogenesis of thrombosis are blood flow stasis, endothelial injury and hypercoagulability states [3]. The postpartum period is known to facilitate the occurrence of blood stasis due to collapse of the ovarian vein that was hitherto three times larger with sixty times increase in blood flow during pregnancy [3]. A physiologic hypercoagulability resulting from increased production of clotting factors I, II, VII, X and XI and increase platelet adhesiveness are also seen in the puerperium [3]. Endothelial injury is usually triggered by exogenous factors like intrauterine and urinary tract infection [3]. The aim of this paper is to present the clinical outcomes of two cases of postpartum ovarian vein thrombosis diagnosed incidentally at laparatomy. 2. Case 1 A 16-year-old para 2 female presented with 2 days history of right sided lower abdominal pain with associated fever. Five days prior to presentation, she had boy by a traditional birth attendant at home. Examination revealed an ill-looking woman with a temperature of 38.4°C. The uterus was consistent with sixteen weeks pregnancy size. Ultrasound scan showed a right tuboovarian mass that measured 7.2？cm × 6.0？cm. The uterine cavity was empty. A clinical diagnosis of right tuboovarian mass with torsion was made. Packed cell volume was 31% and there was leucocytosis of 13.0 × 109/L. She had laparotomy. Intraoperatively, a thrombosed right ovarian vein was found with oedematous right adnexium (Figure 1). She had transection and ligation of the right ovarian vein. Postoperatively, she was placed on antibiotics (metronidazole and ceftriaxone), analgesia (pentazocine), and subcutaneous