Poporodna tromboza ovarialne vene in hidronefroza

Abstract

Three weeks after delivery, a 22-year old woman presented to urology with fever, abdominal and right-sided ank 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 identied 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 signicant 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 detailed risk evaluation and consideration of thromboprophylaxis. Ovarian vein thrombophlebitis should be suspected in any postpartum patient with unexplained fever and abdominal pain.