Article Text

  1. J. Frost1,
  2. S. Elkins1
  1. 1University of Mississippi Medical Center, Jackson, MS.


Purpose To present a case of idiopathic ovarian vein thrombosis as a rare cause of abdominal pain.

Methods A 31-year-old African American female presented with the chief complaint of a 48-hour history of abdominal pain associated with subjective fever, nausea, and dysfunctional uterine bleeding. She had no prior history of clotting but did disclose a previous spontaneous abortion. Her mother experienced a prior clotting episode. Physical examination revealed left adnexal tenderness. Subsequent CT scan demonstrated left ovarian thrombosis without any other noted abnormalities. Anticoagulation was initiated with unfractionated heparin and warfarin. Coagulation profiles were monitored.

Results The patient remained on heparin until a therapeutic INR could be achieved. Partial coagulation studies were obtained after initiation of anticoagulation. Homocysteine, methyltetrahydrofolate reductase gene, anticardiolipin antibody, 20210A mutation, factor V Leiden mutation, and lupus anticoagulant were all unremarkable. Pelvic examination revealed the patient to have Chlamydia, which was treated with appropriate antibiotic therapy.

Conclusions Ovarian vein thrombosis (OVT), although rare, must be considered in the differential diagnosis of abdominal pain in the female patient population. Early diagnosis and treatment are essential to avoid the potentially severe sequelae of thrombophlebitis, deep sepic pelvic thrombophlebitis, or pulmonary embolus. The syndrome involves acute abdominal pain and fever and can be easily diagnosed by sonography or CT studies. Acute appendicitis, especially when involvement of the right ovarian vein exists, is usually high in the differential and must be excluded early. Most OVT occurs after pelvic surgical procedures; however, many cases have been discovered as complications of pelvic inflammatory disease (PID). It is suspected that our patient suffered from PID as her cervical cultures grew Chlamydia. Her abdominal pain quickly diminished after initiation of anticoagulation and antibiotic therapy. She is to complete a 6-month course of warfarin therapy. Completion of hypercoagulation studies will be obtained at the conclusion of anticoagulation.

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