A rare association of puerperal ovarian venous thrombosis with pseudomembranous colitis

Authors

  • Devika J. Kamat Department of Obstetrics and Gynaecology, Goa Medical College, Bambolim, Goa, India
  • Namrata P. Kavlekar Department of Radiodiagnosis, Goa Medical College, Bambolim, Goa, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204331

Keywords:

Puerperal fever, Colitis, Venous thrombosis

Abstract

Ovarian venous thrombosis is a rare but serious complication associated with early puerperium. The risk of this complication increases with associated puerperal infection or inflammatory condition. The present case report is of a 36-year-old lady who presented after emergency caesarean with puerperal fever and abdominal pain along with diarrhoea post antibiotic cover. Patient presented with moderate ascites and uterine subinvolution on examination. Contrast enhanced computed tomography (CECT) showed evidence of bowel wall edema due of colitis along with ovarian vein thrombosis. Patients had persistent symptoms despite receiving an empirical course of injectable cephalosporins. Stool culture confirmed growth of Clostridium difficile. Patient developed a rare infection after a course of antibiotic i.e. pseudomembranous colitis caused by Clostridium difficile. Patient then received a course of injectable vancomycin after which colitis subsided. This case increases our vigilance on management of puerperal fever which could get complicated with life-threatening events like deep vein thrombosis.

Author Biography

Devika J. Kamat, Department of Obstetrics and Gynaecology, Goa Medical College, Bambolim, Goa, India

working as a Gynaecologist in Indian Navy

References

Cunningham FG, Lenovo KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al, editors. Williams Obstetrics. 24th ed. New York: McGraw-Hill. 2014;52:1028-9.

Sultan AA, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol. 2002;156(3):366-73.

Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis: a prospective study. Ann Internal Med. 1974;81(4):429-33.

Owens RC, Donskey CJ, Gaynes RP, Loo VG, Muto CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infectious Dis. 2008;46(1):19-31.

Jon Mark Hirshon, Angela D. Thompson, Brandi Limbago, L. Clifford McDonald, Michelle Bonkosky, Robert Heimer et al. Clostridium difficile Infection in Outpatients, Maryland and Connecticut, USA, 2002–2007. Emerg Infectious Dis. 2011;17(10):1946-9.

Salomon O, Dulitzky M, Apter S. New observations in postpartum ovarian vein thrombosis: experience of single center. Blood Coagulation & Fibrinolysis. 2010;21(1):16-9.

Jacobson AF, Skjeldstad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium – a register-based case-control study. Am J Obstetr Gynaecol. 2008;198(2):233.

Mwickier DM, Setiawan AT, Evans RS, Erdman WA, Stettler RW, Brown CE, et al. Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography. Am J Roentgenol. 1997;169(4):1039-43.

Harris K, Mehta S, Iskhakov E, Chalhoub M, Maniatis T, Forte F, Alkaied H. Ovarian vein thrombosis in the nonpregnant woman: an overlooked diagnosis. Therapeutic Advances in Hematol. 2012;3(5):325-8.

Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Emerging infections program healthcare-associated infections and antimicrobial use prevalence survey team. Multistate point-prevalence survey of health care-associated infections. New Engl J Med. 2014;370(13):1198-208.

Sartelli M, Di Bella S, McFarland LV, Khanna S, Furuya-Kanamori L, Abuzeid N, et al. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients. World J Emergency Surg. 2019;14(8):1-29.

Downloads

Published

2020-09-25

Issue

Section

Case Reports