Pelvic Vein Thrombophlebitis

Aka: Pelvic Vein Thrombophlebitis, Iliac Vein Thrombophlebitis, Postpartum Pelvic Thrombophlebitis, Septic Pelvic Thrombophlebitis, Suppurative Pelvic Thrombophlebitis, Ovarian Vein Thrombophlebitis

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II. Causes

  1. Common
    1. Pelvic Inflammatory Disease
    2. Postpartum Complication (e.g. Postpartum Endometritis)
      1. Cesarean Section (1 in 800 deliveries)
      2. Vaginal Delivery (1 in 9000 deliveries)
  2. Uncommon
    1. Post-operative Hysterectomy
    2. Pelvic Neoplasm

III. Types

  1. Deep Septic Pelvic Thrombophlebitis (DSPT)
  2. Ovarian Vein Thrombophlebitis (OVT)

IV. Findings:

  1. Fever
    1. Onset within 3-5 days of delivery for DPST, and within 7 days of delivery for OVT
    2. Postpartum Fever is often the only presenting symptom in Deep Septic Pelvic Thrombophlebitis (DSPT)
    3. Fever is often refractory to antibiotics
  2. Abdominal Pain
    1. Often absent for Deep Septic Pelvic Thrombophlebitis (DSPT)
    2. Unilateral abdominal or Pelvic Pain, back pain or Flank Pain

V. Labs

  1. Complete Blood Count
    1. Mild Leukocytosis
  2. Blood Culture
    1. Test Sensitivity <33%

VI. Imaging

  1. Precautions
    1. Negative imaging does not exclude Pelvic Vein Thrombophlebitis
  2. Ultrasound
    1. Evaluate for other causes of Postpartum Fever
  3. CT or MRI (esp. MRI Venography)
    1. Pelvic Vein intraluminal filling defect

VII. Differential Diagnosis

  1. Appendicitis
  2. Postpartum Endometritis
  3. Urinary infection
  4. Ovarian Torsion
  5. Pelvic abscess
  6. Pelvic Inflammatory Disease

VIII. Management

  1. Anticoagulation
    1. Limited evidence for adequate duration (2-6 weeks)
    2. Start with Heparin (e.g. Enoxaparin)
    3. Transition to Warfarin or DOAC (e.g. Apixaban)
  2. Antibiotic Management
    1. Similar to Postpartum Endometritis
    2. Preferred regimens
      1. Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 8 hours OR
      2. Ceftriaxone 2 g IV every 24 hours and Metronidazole 500 mg IV every 8 hours OR
      3. Imipenem or Meropenem if ESBL or other multi-drug resistant Gram Negative Bacteria suspected
    3. Alternative regimens
      1. Ciprofloxacin 400 mg IV every 12 hours and Metronidazole 500 mg IV every 8 hours

IX. Complications

  1. Venous Thromboembolism (uncommon)

X. References

  1. (2018) Sanford Guide, accessed on IOS, 10/7/2019
  2. da Silva Cunha (2018) Case Rep Womens Health 17: 5–7 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869062/

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Related Studies

Ontology: Thrombophlebitis of pelvic vein (C0235510)

Concepts Pathologic Function (T046)
SnomedCT 95449003
English THROMBOPHLEBITIS PELVIC VEIN, thrombophlebitis of pelvic vein (diagnosis), Thrombophlebitis of pelvic vein, Thrombophlebitis of pelvic vein (disorder), Thrombophlebitis pelvic vein
Dutch tromboflebitis bekken venen
French Thrombophlébite pelvienne, THROMBOPHLEBITE PELVIENNE
German Thrombophlebitis Beckenvenen, THROMBOPHLEBITIS BECKENVENE
Italian Tromboflebite di vena pelvica
Portuguese Tromboflebite das veias pélvicas, TROMBOFLEBITE DAS VEIAS PELVICAS
Spanish Tromboflebitis de vena pélvica, TROMBOFLEBITIS VENAS PELVIANAS, tromboflebitis de la vena pélvica (trastorno), tromboflebitis de la vena pélvica
Japanese 血栓性骨盤静脈炎, ｹｯｾﾝｾｲｺﾂﾊﾞﾝｼﾞｮｳﾐｬｸｴﾝ
Czech Tromboflebitida pánevní žíly
Hungarian Pelvikus vena thrombophlebitise
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Postpartum pelvic thrombophlebitis (C0269953)

Concepts Pathologic Function (T046)
ICD10 O87.1
SnomedCT 67486009
English Pelvic thrombophlebitis, postpartum, venous complic in preg/puerperium - postpartum pelvic thrombophlebitis, Postpartum pelvic thrombophlebitis (diagnosis), Postpartum pelvic thrombophlebitis, Postpartum pelvic thrombophlebitis (disorder), pelvis; thrombophlebitis, postpartum, thrombophlebitis; pelvic, postpartum
Dutch bekken; tromboflebitis, post partum, tromboflebitis; bekken, post partum
Spanish tromboflebitis pélvica posparto, tromboflebitis pélvica postparto (trastorno), tromboflebitis pélvica postparto
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Thrombophlebitis of iliac vein (C0347887)

Concepts Disease or Syndrome (T047)
SnomedCT 195428003, 312587007, 42861008
English Thrombophleb.iliac vein unspec, Thrombophlebitis of the iliac vein unspecified, thrombophlebitis of iliac vein (diagnosis), thrombophlebitis of iliac vein, Thrombophlebitis of the iliac vein unspecified (disorder), Thrombophlebitis of iliac vein, Thrombophlebitis of iliac vein (disorder)
Spanish tromboflebitis de la vena ilíaca, no especificada (trastorno), tromboflebitis de la vena ilíaca, no especificada, tromboflebitis de la vena ilíaca (trastorno), tromboflebitis de la vena ilíaca
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Thrombophlebitis septic pelvic (C0860283)

Concepts Pathologic Function (T046)
Dutch tromboflebitis septisch van het bekken, septische bekkenstreektromboflebitis
French Thrombophlébite pelvienne septique
German Thrombophlebitis, septisch, Becken, septische Thrombophlebitis des Beckens
Italian Tromboflebite pelvica settica, Tromboflebite settica della pelvi
Portuguese Tromboflebite séptica pélvica, Tromboflebite pélvica séptica
Spanish Tromboflebitis pélvica séptica, Tromboflebitis séptica pélvica
Japanese 化膿性骨盤血栓静脈炎, ｶﾉｳｾｲｺﾂﾊﾞﾝｹｯｾﾝｼﾞｮｳﾐｬｸｴﾝ
Czech Septická pánevní tromboflebitida
English Septic pelvic thrombophlebitis, Thrombophlebitis septic pelvic
Hungarian Thrombophlebitis, septikus, pelvikus, Septicus pelvikus thrombophlebitis
Derived from the NIH UMLS (Unified Medical Language System)

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