Case Presentation:
A 63‐year‐old female with a history of type II diabetes and hypertension was admitted to the hospital with two weeks of nausea, vomiting, and diarrhea and one week of abdominal pain. On admission, her BP was 86/63mmHg, T = 102°F, RR = 16, and HR = 110. Her physical exam was significant for icteric sclerae, dry oral mucosa, a soft abdomen with bowel sounds, left lower quadrant tenderness without guarding and a negative stool guaiac. Her laboratory values were: WBC 12,000 mm3, hemoglobin 11.6 g/dl, platelets 286,000 mm3, amylase 62 U/l, lipase 43 U/l, BUN 27 mg/dl, and creatinine 1.7 mg/dl. Liver function tests were normal and blood cultures were negative. An abdominal CT scan with PO contrast showed thickening of the descending colon wall and fat stranding consistent with diverticulitis with no intestinal obstruction; however, a right gonadal vein intraluminal thrombus was noted. An intravenous heparin infusion was initiated and a vascular surgery consultant recommended 3 months of warfarin anticoagulation to maintain an INR between 2‐3. She was discharged home on a one‐week course of oral ciprofloxacin and metronidazole and was instructed to follow up with the outpatient warfarin center for INR monitoring.
Discussion:
Gonadal vein thrombosis is an uncommon but potentially serious disorder associated with a variety of pelvic conditions, most notably recent childbirth. However, gonadal vein thrombosis has been reported to occur in men with malignancy and other hypercoagulable conditions. Ordinarily an incidental finding, gonadal vein thrombosis becomes serious when complicated by infection. During a 31‐month period, evidence of gonadal vein thrombosis was demonstrated by computed tomography in seven patients who had a broad spectrum of acute gastrointestinal inflammatory lesions, including diverticulitis, ulcerative colitis, Crohn's disease, appendicitis with abscess, and perforated appendix with pseudomembranous colitis (Radiology 10/91 Jain K, et. al) possibly secondary to both the anatomical proximity and intensity of the intraabdominal inflammatory response. CT demonstrated thrombus through the length of the gonadal vein in each patient. Gonadal vein thrombosis may resolve with treatment of the underlying enteric disease alone. However, anticoagulant therapy is occasionally necessary depending on the severity of the condition and extension of the thrombus estimated by imaging studies, because gonadal vein thrombosis may become complicated by inferior vena cava or renal vein thrombosis, resulting in pulmonary embolism or death (5% of complications).
Conclusion:
Gonadal vein thrombosis is an uncommon condition associated with a variety of intra‐abdominal and pelvic processes. Clinicians need to be aware of its associations and treatment modalities to prevent potentially life‐threatening complications.
Author Disclosure Block:
A. Gottesman, None; C. Saifan, None.