Puerperal ovarian vein thrombosis accompanied by hydronephrosis

Abstract

Three weeks after delivery, a 22-year old woman presented to urology with fever, abdominal and right-sided flank pain. Hydronephrosis was diagnosed with iv-pyelography and treated with JJ-stent drainage and antibiotics for suspected pyelonephritis. On the third day oedema of the right leg appeared, which prompted further investigations. CT identified ovarian vein thrombosis as a cause of hydronephrosis, and further thrombosis of the inferior vena cava, iliacal and deep veins of both upper legs. Anticoagulant treatment with low-molecular-weight-heparin and later warfarin resulted in partial recanalisation of thrombi.The patient is double heterozygous for factor V Leiden and prothrombin mutation. Although recent literature negates this as a significant risk factor, presence of other, more obvious and easily recognizable risk factors (previous spontaneous abortions, smoking, bed rest, obesity, non-O blood group...) should have prompted detailedrisk evaluation and consideration of thromboprophylaxis.Ovarian vein thrombophlebitis should be suspected in any postpartum patient with unexplained fever and abdominal pain.

Keywords

• puerperal period
• venous thrombosis
• abdominal pain
• blood coagulation factors
• ureteral obstruction