Diagnosis and management of ovarian vein thrombosis after cesarean section: a case report and literature review

doi:10.3877/cma.j.issn.1673-5250.2021.01.009

Objective

To investigate clinical features, diagnosis and management of ovarian vein thrombosis (OVT) after cesarean section.

Methods

The 26-year-old patient with OVT after cesarean section who was admitted to Minhang Hospital, Fudan University on August 23, 2019 were selected as the study subject. Clinical data of the patient were collected by retrospective analysis method, and clinical features, imaging data, diagnosis and treatment protocols were analyzed. With keywords of " after cesarean section" " ovarian vein thrombosis" " caesarean " , literatures related with OVT after cesarean section were retrieved from PubMed, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform. Literature retrieval time was set on January 1, 2000 to January 1, 2021. Clinical characteristics, diagnosis, treatment protocols of OVT patients after cesarean section were summarized. This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①This patient was 26-year-old who underwent cesarean section due to scarred uterus, and operation was successful. On the third postoperative day, the patient developed abdominal distension and pain with low-grade fever, with white blood cell count of 11.43×10⁹/L. The results of ultrasonography showed a long anechoic area on the medial side of the right renal hilum, about 109 mm × 14 mm, with unclear boundary and twisted course near the renal hilum. This patient was diagnosed as right OVT after cesarean section. Oral warfarin (2.5 mg/d) anticoagulation was given, and the patient was discharged with improved condition 16 days after surgery.The patient was continued treatment with anticoagulation for 6 months after discharge, then follow-up her by ultrasound examination showed disappearance of the right OVT.②Literatures review results revealed that 12 pieces of literature about OVT after cesarean section were retrieved according to literature search strategies in this study. Among 12 patients, 1 had left-sided OVT and 11 had right-sided OVT (2 cases involved renal vein, 3 with venous thrombosis, and 1 with pulmonary embolism); 3 were over 35 years old and 9 were under 35 years old; 8 patients with OVT occurred within 1 week after operation, 3 cases occurred within 1-2 weeks after operation and 1 case occurred within 3 weeks after operation; their first symptoms were lumbago (4 cases), abdominal pain (8 cases), and fever (7 cases); and laboratory findings revealed increased of white blood cell counts in 6 cases.

Conclusions

OVT after cesarean section is a rare postpartum disease, and its clinical manifestations are nonspecific. CT examination can help diagnosis of OVT after cesarean section, and anticoagulant therapy is the main treatment proposal for OVT patients after cesarean section. For patients with abdominal pain and fever after cesarean section, be alert to the possibility of OVT. Early diagnosis and treatment can improve the prognosis of OVT patients.

Key words: Cesarean section, Postpartum period, Ovary, Venous thromboembolism, Anticoagulants, Heparin, low-molecular-weight, Ultrasonography, Women

图1 1例剖宫产术后右侧OVT患者(26岁)术后第5天超声声像图(CDFI示未见明显血流信号)

图2 1例剖宫产术后右侧OVT患者(26岁)术后第10天腹部增强CT影像图(右侧肾盂积水扩张，右侧输尿管旁、子宫右侧旁管状结构)

图3 1例剖宫产术后右侧OVT患者(26岁)术后3个月超声声像图(血栓明显缩小，约为57 mm×7 mm)(白色箭头所指为OVT)

表1 12例剖宫产术后OVT患者的临床资料

文献(第1作者，文献发表年)	血栓类型	年龄(岁)	剖宫产指征	其他高危因素	术后发病时间(d)	首发症状	最高体温(℃)	白细胞计数(×10⁹/L)	抗凝治疗时间
刘玉凤^[11]，2018	右侧OVT	30	产程停滞	肥胖	6	右侧腰痛	38.0	14.7	6个月
郭晓玥^[12]，2012	左侧OVT	25	体外受精	无	6	左侧腰痛	39.0	17.1	6周
刘颂平^[13]，2012	右侧OVT合并肾静脉受累	32	疤痕子宫	无	6	右侧腰痛	37.2	7.5	6周
Cao^[6]，2020	右侧OVT合并下腔静脉血栓	30	胎儿宫内窘迫	肥胖	2	右下腹疼痛、腰部疼痛	37.0	8.9	3 d
Hadas-Halpern^[14]，2002	右侧OVT	38	双胎妊娠	高龄	27	下腹疼痛	37.0	7.5	6周
Djakovic^[15]，2015	右侧OVT	31	胎儿宫内窘迫	肥胖	10	右侧腹股沟疼痛	37.0	9.0	6个月
Angelini^[16]，2013	右侧OVT合并肾静脉受累	31	双胎妊娠	无	1	腹痛、呕吐、腹泻	38.2	13.7	6周
Fatema^[17]，2019	右侧OVT	28	胎儿宫内窘迫	无	2	右下腹疼痛	39.8	15.6	3个月
Stergaard^[18]，2018	右侧OVT	35	双胎妊娠	产后出血	4	右下腹疼痛、肿胀	37.0	8.7	3个月
Aguirre^[19]，2000	右侧OVT合并下腔静脉血栓	18	妊娠期高血压疾病	无	3	下腹疼痛	39.0	12.3	6个月
Meurette^[20]，2003	右侧OVT合并肺栓塞	39	胎膜早破	无	12	下腹疼痛	38.0	15.0	6个月
Morales-Rosello^[21]，2004	右侧OVT合并下腔静脉血栓	19	社会因素	红斑狼疮	2	下腹疼痛	39.0	8.0	1个月

表1 12例剖宫产术后OVT患者的临床资料

文献(第1作者，文献发表年)	血栓类型	年龄(岁)	剖宫产指征	其他高危因素	术后发病时间(d)	首发症状	最高体温(℃)	白细胞计数(×10⁹/L)	抗凝治疗时间
刘玉凤^[11]，2018	右侧OVT	30	产程停滞	肥胖	6	右侧腰痛	38.0	14.7	6个月
郭晓玥^[12]，2012	左侧OVT	25	体外受精	无	6	左侧腰痛	39.0	17.1	6周
刘颂平^[13]，2012	右侧OVT合并肾静脉受累	32	疤痕子宫	无	6	右侧腰痛	37.2	7.5	6周
Cao^[6]，2020	右侧OVT合并下腔静脉血栓	30	胎儿宫内窘迫	肥胖	2	右下腹疼痛、腰部疼痛	37.0	8.9	3 d
Hadas-Halpern^[14]，2002	右侧OVT	38	双胎妊娠	高龄	27	下腹疼痛	37.0	7.5	6周
Djakovic^[15]，2015	右侧OVT	31	胎儿宫内窘迫	肥胖	10	右侧腹股沟疼痛	37.0	9.0	6个月
Angelini^[16]，2013	右侧OVT合并肾静脉受累	31	双胎妊娠	无	1	腹痛、呕吐、腹泻	38.2	13.7	6周
Fatema^[17]，2019	右侧OVT	28	胎儿宫内窘迫	无	2	右下腹疼痛	39.8	15.6	3个月
Stergaard^[18]，2018	右侧OVT	35	双胎妊娠	产后出血	4	右下腹疼痛、肿胀	37.0	8.7	3个月
Aguirre^[19]，2000	右侧OVT合并下腔静脉血栓	18	妊娠期高血压疾病	无	3	下腹疼痛	39.0	12.3	6个月
Meurette^[20]，2003	右侧OVT合并肺栓塞	39	胎膜早破	无	12	下腹疼痛	38.0	15.0	6个月
Morales-Rosello^[21]，2004	右侧OVT合并下腔静脉血栓	19	社会因素	红斑狼疮	2	下腹疼痛	39.0	8.0	1个月

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