Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3877-3884
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3877
Postpartum ovarian vein thrombosis after cesarean section and vaginal delivery: Two case reports
Hong-Dan Zhu, Wei Shen, He-Li Wu, Xia Sang, Yun Chen, Li-Shu Geng, Tao Zhou
Hong-Dan Zhu, Wei Shen, He-Li Wu, Xia Sang, Yun Chen, Li-Shu Geng, Tao Zhou, Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
Author contributions: Zhu HD and Shen W collected data and drafted the manuscript. Wu HL and Sang X analyzed and interpreted the data; Geng LS and Chen Y contributed to the design of the study and the revision of the manuscript; Zhou T reviewed and approved the final manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Zhou, Doctor, Occupational Physician, Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, No. 728 Yucai North Road, Xiaoshan District, Hangzhou 311200, Zhejiang Province, China.zhoutao1417@163.com
Received: March 10, 2023
Peer-review started: March 10, 2023
First decision: April 10, 2023
Revised: April 18, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 6, 2023
Processing time: 83 Days and 19.9 Hours
Abstract
BACKGROUND

Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical symptoms and signs. This paper reports two patients who developed right ovarian vein thrombosis after cesarean section and vaginal delivery, respectively.

CASE SUMMARY

Case 1 was a 32-year-old female who underwent a cesarean section in labor at 40 wk of gestation due to fetal distress. The patient was persistently febrile after the operation and escalated antibiotic treatment was ineffective. POVT was diagnosed by abdominal computed tomography (CT) and was treated by increasing the dose of low molecular weight heparin (LMWH). Case 2 was a 21-year-old female with a spontaneous vaginal delivery at 39 wk of gestation. The patient developed fever and abdominal pain 3 days after delivery. POVT was promptly identified by abdominal CT, and the condition was quickly controlled after treatment with LMWH and antibiotics.

CONCLUSION

These two cases occurred after cesarean section and vaginal delivery, respectively. The diagnosis was mainly based on imaging examination due to the unspecific clinical symptoms and signs, the CT scan provided an especially high diagnostic value. Comparing these two cases, escalating antibiotics alone did not provide significant therapeutic benefit, but the early escalation of anticoagulant dosage seemed to shorten the disease course. Therefore, early diagnosis by CT followed by aggressive anticoagulation might have a positive effect on improving the prognosis of the disease.

Keywords: Postpartum ovarian vein thrombosis; Computed tomography; Anticoagulation; Anti-infection; Case report

Core Tip: Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical symptoms and signs. Retrospective literature showed that anticoagulation and anti-infection agents constituted the main treatment modalities for this disease, and the definite diagnosis before treatment mainly depended on imaging diagnosis, especially computed tomography (CT) scans. This paper reports two cases in which early diagnosis and timely treatment likely led to a shorter disease course. Therefore, for patients in whom POVT is suspected, an early CT scan can assist in the early diagnosis. Of course, in view of radiation and other side effects, the clinical overuse of CT scans should still be avoided.