Post-partum right ovarian vein thrombosis mimicking acute appendicitis: a rare entity

Abstract

Postpartum ovarian vein thrombosis (OVT) is a rare condition that must be distinguished from other causes of acute abdominal pain because it presents with non-specific, predominantly lower abdominal pain. If the right ovarian vein is involved, pain would be predominantly right-sided and may be missed for acute appendicitis. OVT has been reported to occur in 0.05% to 0.18% in the postpartum period following normal vaginal deliveries, and in up to 2% following caesarean sections. Untreated, postpartum OVT can lead to serious consequences such as sepsis, pulmonary embolism, and even death. We share a case that was admitted to our hospital with symptoms of acute appendicitis that proved later to be due to postpartum ovarian thrombosis. A 28-year-old woman was admitted to our hospital on her 4^th postpartum day, following a spontaneous vaginal delivery of a live born full term female baby, complaining of anorexia, nausea, and abdominal pain in her right lower quadrant accompanied by low grade fever. On examination, she appeared ill and had a significant tenderness in her right lower quadrant. An ultrasonography did not reveal any abnormality and did not visualize her appendix. Patient was referred to a consultant gynecologist and was discharged as having no obstetric nor gynaecological cause of her complaint. Patient was admitted to general surgery department where a venography CT of her abdomen confirmed a thrombus in the right ovarian vein with a normal appendix. Blood tests were positive for anticardiolipin. Patient was treated conservatively and responded well to treatment with low molecular weight heparin and antibiotics. OVT is a rare disease, occurring mostly in the postpartum period. Rapid diagnosis is needed to prevent serious consequences and unnecessary surgical procedures, especially when mimicking an acute abdomen.