Ovarian vein thrombophlebitis: a potentially fatal differential of pyelonephritis

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Ovarian vein thrombophlebitis (OVT) is a potentially fatal disease occurring in the postpartum period. Although OVT can be fatal owing to complications such as pulmonary embolism or sepsis, it is often under-recognised and misdiagnosed as appendicitis or pyelonephritis owing to its rarity. Our paper describes a case of a previously healthy 35-year-old woman with postpartum right OVT. The patient presented with fever and right flank pain for a month, which started a week after an uneventful delivery. Although a gynaecologic consultant made a diagnosis of acute pyelonephritis, several imaging studies supported a diagnosis of postpartum right OVT complicated with thrombus in the inferior vena cava. We treated the patient with ampicillin-sulbactam and anticoagulation with intravenous heparin and subse- quently, oral warfarin. The patient improved without complications. Our experience underpins the importance of precisely taking the gynecological history of patients with acute abdomen and considering OVT as a possible cause of acute abdomen or fever in the postpartum period.