2nd Department of Surgery, Athens University School of Medicine, Aretaieion Hospital, Athens, Greece.
World J Emerg Surg. 2011 Dec 23;6(1):45. doi: 10.1186/1749-7922-6-45.
Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.
A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.
Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT.
OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.
卵巢静脉血栓形成（OVT）是一种罕见但严重的疾病，主要影响产后妇女。为了诊断这种不常见的腹痛原因，需要高度怀疑。
一名 19 岁的女性，产后三天，因严重右下象限腹痛和 38.5°C 发热被收入我院。体格检查发现患者病情严重，右下象限压痛，有阳性反弹和乔尔达诺征。患者行阑尾切除术，证实急性阑尾炎阴性。术后发热和疼痛持续存在，腹部 CT 扫描静脉造影剂显示右侧卵巢静脉血栓形成。患者开始接受低分子肝素（LMWH）和抗生素治疗，一个月后新的腹部 CT 扫描显示右侧卵巢静脉通畅。
OVT 的病理生理学解释为 Virchow 三联征，因为妊娠与高凝状态、子宫压迫下腔静脉引起的静脉淤滞以及分娩时或局部炎症引起的内皮损伤有关。OVT 的常见症状和体征包括下腹部或侧腹痛、发热和白细胞增多，通常在分娩后十天内出现。OVT 的报告发病率为 0.05-0.18%的妊娠，大多数情况下是右侧卵巢静脉受累。抗凝和抗生素是 OVT 的主要治疗方法。OVT 的并发症包括败血症、血栓延伸至下腔静脉和肾静脉以及肺栓塞。肺栓塞的发生率为 13.2%，是 OVT 死亡的主要原因。
OVT 是一种罕见的疾病，通常发生在产后。特别是在类似于急性腹痛的情况下，需要高度怀疑以进行及时诊断和治疗。
