A case of ovarian vein thrombosis with acute pelvic inflammatory disease

Abstract

When a women patient presents to the hospital with lower abdominal pain, the accurate diagnosis of ovarian vein thrombosis (OVT) could be easily delayed because it is a rare cause. This diagnosis should be considered not only in postpartum patients but also in women with pelvic infl ammatory disease (PID). We report a case of OVT along with PID, which is detected by a computed tomography scan and treated successfully with anticoagulation therapy.Keywords: Ovarian vein; Thrombosis; Pelvic infl ammatory disease CASE REPORT Received: 2011. 5.11. Revised: 2011. 7.27. Accepted: 2011 Ovarian vein thrombosis (OVT) is a rare cause of acute abdominal pain, and it affects approximately 1 in 2,000 deliveries or abortion [1]. However, this diagnosis should be considered not only in postpartum patients but also in women with pelvic infl ammatory disease (PID), with malignancy, who went through recent abdominal surgery, or has known hypercoagulable state [2]. Common symptoms of OVT are fever, nausea, vomiting, chills, lower abdominal pain, tachycardia, and fl ank pain. The clinical manifestations are variable from asymptomatic and dull abdominal pain to sepsis, pulmonary embolism and life threatening events. The complications of OVT can be significant, so careful diagnosis, which is based on computed tomography (CT), color Doppler ultrasonography and magnetic resonance imaging (MRI), is important [3]. Differential diagnosis must be included appendicitis, peritonitis, adnexal torsion, tubo-ovarian abscess, ectopic pregnancy, intussusception, and pyelonephritis [1]. We report a case of a patient presenting with OVT which is accompanied with PID, and review the diagnostic and therapeutic options for this disease. Case ReprotA 27-year-old healthy nulliparous woman was visited Gangnam Severance Hospital emergency department with one day of aggravating right lower quadrant pain. The past medical history and review of systems were not remarkable. There was no family history of hypercoagulable state. Transvaginal ultrasound was within normal range. The abdomino-pelvic CT revealed mild pelvic ascites with smooth peritoneal thickening which is suggesting PID. She was admitted to gynecologic department under the impression of PID and received an intravenous aminoglycoside and metronidazole for 8 days as a empirical antibiotic treatment. She had vaginal discharge and the result of cervical culture was positive for gardnerella and chlamydia. The patient was discharged after 8 days hospital stay with mild improvement in her symptom. She was to continue 1 week of oral aminoglycoside and metronidazole. After 5 days, she revisited emergency department for recurrent abdominal pain, which is more aggravated and localized at right lower quadrant area. On physical examination, the patient had