Ovarian Vein Thrombosis: A Rare Postoperative Complication in Patients with Ovarian Cancer

Dutari C, Bustamante M and Noll F

Department of Gynecology, Sanatorio Allende, Ciudad de Córdoba, Argentina Department of Radiology, Sanatorio Allende, Ciudad de Córdoba, Argentina Department of Gynecology, Gynecologic Oncology Unit, Sanatorio Allende, Ciudad de Córdoba, Argentina

^*Correspondance to: Dutari Catalina 

 PDF  Full Text DOI: 10.25107/2474-1647.3698

Abstract

Background: Venous Thromboembolism (VTE) is a major concern in gynecological cancer, particularly in epithelial ovarian cancer. Patients are at a higher risk due to a hypercoagulable state, with an incidence of 120/10,000. Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) poses a 30% to 50% VTE risk. Postoperative and chemotherapy-related deep vein thrombosis rates are 13.65% to 27.0%. The ovarian vessels are an uncommon location for deep vein thrombosis, making it difficult to manage. The most common sites of deep vein thrombosis are in the lower and upper limbs. Prompt diagnosis and treatment reduce mortality from 30% to 10%. ERAS protocols emphasize thromboprophylaxis based on risk scores, starting 12 h pre-surgery and continuing four weeks postoperatively. Managing this postoperative complication requires a comprehensive approach that includes risk assessment, prophylaxis, and vigilant monitoring. Case Report: We present a case of a 47-year-old patient diagnosed with high-grade serous ovarian carcinoma in stage IIA, undergoing primary cytoreduction and adjuvant chemotherapy with Carboplatin + Paclitaxel. Three months post-surgery, she presented to the emergency room with persistent febrile equivalents, nausea, early satiety, mild abdominal pain, and unilateral headache. Clinical examination revealed stable vital signs, abdominal tenderness, and elevated inflammatory markers. Imaging studies indicated thrombosis of the right ovarian vein extending to the vena cava. Anticoagulation therapy was initiated, leading to favorable clinical outcomes. This case highlights the importance of considering VTE in gynecological cancer patients, necessitating vigilant monitoring and prompt intervention to mitigate associated risks. Discussion: The limited research on ovarian vein thrombosis in cancer patients highlights its novelty and clinical importance. While some literature suggests that thromboprophylaxis may not be necessary for chemotherapy outpatients unless they exhibit additional high thrombotic risk factors, recent evidence favors its use in patients undergoing neoadjuvant chemotherapy for ovarian cancer. This approach has been shown to lower rates of Venous Thromboembolism (VTE) without raising the risk of bleeding episodes.

Keywords

Cite the article

Dutari C, Bustamante M, Noll F. Ovarian Vein Thrombosis: A Rare Postoperative Complication in Patients with Ovarian Cancer. Clin Surg. 2024; 9: 3698.