Case ReportOvarian vein thrombosis after total laparoscopic hysterectomy with unilateral adnexectomy: A case report

- Symptoms are often not specific and may include fever, abdominal pain, flank and back pain.
- Treatment is controversial and there is no standard evidence - based protocol; anticoagulation therapy and antibiotics remain the main basic therapy.
- The application of bipolar electrocautery and the pexy of the ovary are possible contributing mechanisms for the thrombus formation.

IntroductionOvarian vein thrombosis is a rare but potentially serious complication after surgical and gynecologic procedures such as oophorectomy and hysterectomy. The association of this event with laparoscopic hysterectomy in particular, is very rare. Only two cases have been described so far.Presentation of caseWe present a case of ovarian vein thrombosis after laparoscopic hysterectomy in a 40-year-old with deep endometriosis and multiple intramural uterine myomas. Laparoscopic hysterectomy, left oophorectomy, right salpingectomy, and suspension (ovariopexy) of the right ovary on the ipsilateral round ligament of the uterus were performed, using bipolar electrocautery as a hemostatic tool.DiscussionThe 7th postoperative day the patient presented to our hospital complaining of abdominal pain and fever. An abdominal CT scan demonstrated a filling defect and enlargement of the right ovarian vein, a finding compatible with ovarian vein thrombosis. She was treated with low molecular weight heparin (LMWH). On the 19th postoperative day, an MRI scan was performed and did not reveal any pathological findings of the right ovarian vein. The patient was discharged on LMWH for three months. Post treatment evaluation for thrombophilia was negative for pathological findings.ConclusionOur case is a very rare condition. Only two 'similar' cases have been described in the literature so far. Bipolar electrocautery and ovariopexy on the ipsilateral round ligament during laparoscopic hysterectomy should be evaluated further as possible contributing mechanisms for the thrombus formation.