Postpartum Ovarian Vein Thrombophlebitis: A Case Report of Two Patients With Literature Review

Postpartum ovarian vein thrombophlebitis (OVT) is a rare but potentially life-threatening vascular complication.Its polymorphic clinical presentation and non-specific symptoms frequently lead to diagnostic delays, increasing the risk of thromboembolic complications.We report two cases of postpartum OVT with distinct clinical presentations illustrating the spectrum of disease severity.The first patient was a 23-yearold gravida 3 para 3 with no notable past medical history who presented on postpartum day four with fever and pelvic pain following vaginal delivery.Despite intravenous antibiotic therapy, fever persisted with onset of polyarthralgia.CT angiography revealed extensive thrombosis involving the inferior vena cava, common iliac veins, right external and internal iliac veins, right ovarian vein, and right renal vein.The second patient was a 44-year-old gravida 4 para 3 with severe rheumatic valvular disease and pulmonary hypertension on antiplatelet therapy who underwent cesarean delivery for fetal distress.On postpartum day two, she developed diffuse abdominal pain with guarding and fever, with C-reactive protein elevation from 23 to 259 mg/L.Abdominopelvic CT demonstrated bilateral ovarian vein thrombosis (right: 16 mm, left: 12 mm).Antiplatelet therapy was discontinued, and both patients were treated with therapeutic-dose low-molecularweight heparin and broad-spectrum antibiotics, and improved clinically.These cases highlight the diagnostic challenges of postpartum OVT, particularly its variable clinical presentation and spectrum of severity.Persistent postpartum fever unresponsive to antibiotics should raise suspicion of OVT and prompt early imaging; contrast-enhanced CT was the modality used in both cases.Both patients improved clinically under combined anticoagulant and antibiotic therapy, although no conclusion on efficacy can be drawn from two cases, and the shorter anticoagulation duration in Case 2 was an individualized decision that should not be generalized.Multidisciplinary involvement was important in our complex case.