The challenges of diagnosing idiopathic ovarian vein thrombosis: Case report

INTRODUCTION: Abdominal pain is a common clinical challenge presenting to the emergency department. The challenge lies in the wide differentials particularly in females due to the addition of potential gynecological conditions. Ovarian vein thrombosis (OVT) is one of the uncommon differentials requiring rapid recognition & treatment to avoid serious complications or even death. CASE PRESENTATION: We report a 42-year-old healthy female, post normal vaginal delivery 1- year prior to presentation. She presented with left iliac fossa and periumbilical pain for 1-day with no other symptoms. She was vitally stable. Abdominal & pelvic examinations revealed left lower tenderness with guarding. Laboratory investigations were within normal. Abdominal Doppler showed a dilated left ovarian vein with absent flow and Computed tomography (CT) scan confirmed the presence of a thrombus. Therefore, the diagnosis of OVT was made and she was started on anticoagulation. DISCUSSION: OVT is a rare, life-threatening condition occurring mainly during the post-partum period (0.18% post vaginal delivery). Diagnosing ovarian vein thrombosis can be challenging because of the overlapping presentation with other differentials. A high index of suspicion should be kept in females presenting with abdominal pain. Standard guidelines for managing OVT are lacking. However, lower limb DVT guidelines have been suggested in the literature to be applicable. CONCLUSION: The initial modality of diagnosing OVT is Doppler ultrasound. However, CT and MRA confirm the diagnosis in case of uncertainty. The mainstay of treatment is the conservative approach while the surgical approach is reserved for persistent OVT despite appropriate conservative therapy.