Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3877
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
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 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.
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.
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.