Zabihi Mahmoudabadi Hossein, Najjari Khosrow, Oklah Edmund, Kor Farhad
Sina Hospital, Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Sina Hospital, Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2021 Jun;83:105975. doi: 10.1016/j.ijscr.2021.105975. Epub 2021 May 12.
Ovarian vein thrombosis (OVT) is exceedingly rare, which commonly occurs in postpartum patients and can result in serious complication such as pulmonary emboli. With a presentation often mimicking that of acute abdomen, it can be often misdiagnosed and mistreated.
A 30-year-old woman referred with right lower quadrant abdominal pain, nausea and anorexia, one week after normal vaginal delivery. Physical examination demonstrated tenderness and rebound tenderness at the right side of the abdomen, with a stable vital sign except 38 °C fever. She had no history of coagulation problems or thrombotic disorders. Patient was admitted on a suspicion of appendicitis and was prescribed antibiotics followed by pelvic and abdominal ultrasonography that indicated an 8 to 10-centimeter hypoechoic tubular structure on the right side, next to the IVC. CT scan with contrast showed clear dilatation and thrombosis of the right ovarian vein with spread to the IVC. Anticoagulant treatment was started with 1000 intravenous units of heparin per hour, along with aPTT control, with a disappearance of the symptoms after 72 h.
Suspicion of OVT should be high in cases where patients refer with abdominal pain after childbirth, this diagnosis should be taken into account. In the absence of proper and timely diagnosis, it may lead to serious complications or mortality of the mother. CT scan with contrast and at least 3- months anticoagulant therapy (in case of thrombosis spreading to the IVC, this period should be extended) is recommended in diagnosing and treatment of OVT.
卵巢静脉血栓形成（OVT）极为罕见，常见于产后患者，可导致严重并发症，如肺栓塞。其临床表现常类似急腹症，常易被误诊和误治。
一名30岁女性在正常阴道分娩一周后因右下腹痛、恶心和厌食前来就诊。体格检查发现腹部右侧有压痛和反跳痛，生命体征平稳，仅体温38°C。她既往无凝血问题或血栓形成疾病史。患者因疑似阑尾炎入院，给予抗生素治疗，随后进行盆腔和腹部超声检查，结果显示右侧下腔静脉旁有一个8至10厘米的低回声管状结构。增强CT扫描显示右侧卵巢静脉明显扩张并伴有血栓形成，血栓已蔓延至下腔静脉。开始每小时静脉注射1000单位肝素进行抗凝治疗，并监测活化部分凝血活酶时间（aPTT），72小时后症状消失。
对于产后出现腹痛的患者，应高度怀疑卵巢静脉血栓形成，需考虑这一诊断。若未进行及时、恰当的诊断，可能导致严重并发症或产妇死亡。在诊断和治疗卵巢静脉血栓形成时，建议进行增强CT扫描，并至少进行3个月的抗凝治疗（若血栓蔓延至下腔静脉，此疗程应延长）。
