Shukr Ghadear, Gonte Madeleine R, Webber Victoria E, Abood Joelle A, Arsanious Samah, Eisenstein David
Department of Minimally Invasive Gynecologic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Gynecol Minim Invasive Ther. 2023 Apr 19;12(2):113-115. doi: 10.4103/gmit.gmit_62_22. eCollection 2023 Apr-Jun.
Postoperative ovarian vein thrombosis (OVT) is a rare complication following hysterectomy. Due to its ambiguous presentation, most frequently presenting as a fever with no known source and lower quadrant abdominal pain, OVTs are commonly diagnosed incidentally on computed tomography as a low-attenuation thrombus in place of the ovarian vein. The cornerstones of OVT treatment include anticoagulation and antibiotic therapy; however, there are no current guidelines to inform provider decision-making regarding specific anticoagulant agents, dosing, or length of therapy. We present a patient with a history of deep-vein thrombosis, who presented to the emergency department with OVT following a laparoscopic hysterectomy. She was treated with apixaban, a direct oral anticoagulant (DOAC), and experienced repeated episodes of vaginal bleeding and hematoma expansion. We present this case to instill a high index of suspicion for OVT after laparoscopic hysterectomy, and to discuss the role of DOACs in patients with thromboembolic disease and concurrent bleeding.
术后卵巢静脉血栓形成（OVT）是子宫切除术后一种罕见的并发症。由于其表现不明确，最常见的表现是不明原因发热和下腹部疼痛，OVT通常在计算机断层扫描时偶然被诊断为卵巢静脉部位的低密度血栓。OVT治疗的基石包括抗凝和抗生素治疗；然而，目前尚无指导方针为医疗人员在特定抗凝剂、剂量或治疗时长的决策提供依据。我们报告一例有深静脉血栓形成病史的患者，她在腹腔镜子宫切除术后因OVT就诊于急诊科。她接受了阿哌沙班（一种直接口服抗凝剂（DOAC））治疗，但出现了反复的阴道出血和血肿扩大。我们展示这个病例是为了提高对腹腔镜子宫切除术后OVT的高度怀疑指数，并讨论DOACs在血栓栓塞性疾病和并发出血患者中的作用。
