Diagnostic laparoscopy and oophorectomy for ovarian vein thrombosis in a patient with COVID-19: a surgical case report and literature review

Abstract

Ovarian vein thrombosis (OVT) is a rare condition most frequently associated with pelvic inflammatory disease (PID), malignancy or the immediate postpartum period. This case study reports on a 56-year-old woman who developed OVT 11 days after a positive COVID-19 diagnosis. Imaging including abdominal/pelvic computed tomography, transvaginal Doppler ultrasound and transabdominal pelvic ultrasound failed to definitively diagnose the thrombotic etiology of the patient’s presentation. Ultimately, laparoscopic visualization and subsequent oophorectomy were necessary for diagnostic and therapeutic purposes. The patient did not have underlying malignancy, recent surgical history, history of PID or any history of previous thromboembolic events. Therefore, this report contributes further evidence to the growing knowledge of systemic manifestations associated with COVID-19 that may require surgical intervention.

Ovarian Vein Thrombosis: A Sequela of COVID-Associated Coagulopathy

“…Symptomatic postpartum OVT occurs in 0.01-0.05% of deliveries, especially in C-sections [17]. In this review, no significant obstetric history was found in the majority of the cases (77.77%) [6,11,13,14,[18][19][20].…”

“…Our review corroborates a similar finding. A total of 66.66% of patients presented within the first two weeks after a COVID-positive test [11,13,[18][19][20][21]. The remaining 33.33% of patients took three to eight weeks for presentation [6,14].…”

“…Coronavirus disease 2019 (COVID- 19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 has infected millions of people and given rise to a global pandemic in just a few months [1,2].…”

Role of SARS-CoV-2-induced cytokine storm in multi-organ failure: Molecular pathways and potential therapeutic options

“…An autopsy study by Wichmann et al reported microthrombi in the prostate of male patients [38] . In female COVID-19 patients, there were also reports of primary ovarian failure (POF) and ovarian vein thrombosis (OVT) [187] , [188] , [189] , [190] , [191] . One study reported POF due to long COVID-19 [192] , and another presented a case of OVT in a pregnant woman [193] .…”

Laparoscopic diagnosis of idiopathic left ovarian vein thrombosis in a 27-year-old woman

“… 3 – 5 Recently, OVT has been associated with COVID 19 infection, presumably because of a hypercoagulable state caused by the virus. 6 , 7…”