Ureteral Obstruction and Hydronephrosis Caused by Postpartum Ovarian Vein Thrombosis

Abstract

Abstract

Background: Ovarian vein thrombosis is an uncommon postpartum event that may complicate vaginal or cesarean deliveries. Diagnosis may be delayed, given the nonspecific clinical symptoms. Case: The case of a patient with right flank and abdominal pain 5 days after a cesarean delivery is presented. Despite adequate hydration, antibiotics, and pain medication, the right flank pain persisted. Concomitantly, the patient's serum creatinine levels increased. Computed tomography revealed a thrombosed right ovarian vein causing right ureteral obstruction and hydronephrosis. Results: Subsequently, the patient required double-J ureteral stent placement, intravenous antibiotics, and anticoagulation, after which she felt much better and required only minimal use of oral pain medication. Her serum creatinine level decreased. She was started on therapeutic enoxaparin, tamsulosin, and ceftriaxone and was discharged on hospital day 5. She continued her enoxaparin for 7 more days and reported no problems on follow-up urologic and gynecologic visits 2 weeks later. Conclusions: Ovarian vein thrombosis should be considered in the differential diagnosis of abdominal or flank pain in the postpartum period. Prompt diagnosis and treatment, especially in the setting of ureteral obstruction, is essential to prevent life-threatening complications. (J GYNECOL SURG 29:158)