What Do I Have?

In septic pelvic vein thrombophlebitis, infected blood clots develop in one or several of the pelvic blood vessels. A thrombus is a blood clot; phlebitis is an inflammation of a vein.

Septic pelvic vein thrombophlebitis is extremely rare, occurring in only one out of every 2,000 pregnancies. It typically develops in women who have endometritis, an infection of the lining of the uterus that occurs after delivery. This infection causes ?seeding? of pathogenic bacteria in the veins. These pathogens may then damage the vascular endothelium (the lining of the blood vessels) and initiate blood clotting (thrombosis). Fortunately, less than 1% of patients with endometritis develop this serious complication.

What are the Consequences of Septic Pelvic Vein Thrombophlebitis?

Septic pelvic vein thrombophlebitis is a potentially dangerous condition. It can lead to the formation of an abscess (collection of pus) in the pelvis and infection in a blood clot which travels from the pelvic vessels to the vessels in the lungs (septic pulmonary embolization). This latter disorder may prevent the delivery of sufficient oxygen to the blood and may result in death.

What Are the Usual Signs and Symptoms of Septic Pelvic Vein Thrombophlebitis?

Most patients with septic pelvic vein thrombophlebitis have an acute thrombosis of one of the major veins in the pelvis (usually the right ovarian vein). The following signs and symptoms are typically noticed within 48 to 96 hours after delivery: a-b

  • fever;
  • abdominal pain, usually localized and restricted to the side of the affected vein but may spread into the groin, upper abdomen, or flank;
  • abdominal bloating and tenderness (most patients do not want to be touched in the abdomen);
  • a tender, sausage-shaped mass near the umbilicus (present in 50 to 70% of patients);
  • decreased or absent bowel sounds;
  • nausea;
  • vomiting; and
  • increased pulse rate (tachycardia).

If pulmonary embolization has occurred, you may experience accelerated breathing (tachypnea), labored breathing (stridor), or shortness of breath (dyspnea).

Some patients with septic pelvic vein thrombophlebitis have less prominent clinical signs and symptoms. They do not appear to be seriously ill and symptoms are limited to persistent fever and rapid heart beat.

Other conditions may cause symptoms similar to those seen in septic pelvic vein thrombophlebitis. Your doctor must distinguish this infection from pyelonephritis (kidney infection), nephrolithiasis (kidney stone), appendicitis, pelvic hematoma (swelling due to a broken blood vessel), twisting of the ovary or tube (torsion), and pelvic abscess. Other possible diagnoses for these symptoms include drug fever, viral syndrome, and a flare of systemic lupus erythematous.

How Is Septic Pelvic Vein Thrombophlebitis Diagnosed?

To be evaluated for suspected septic pelvic vein thrombophlebitis, you may undergo a CT scan (computerized tomography) or MRI (magnetic resonance imaging). These three-dimensional images can detect the presence of large blood clots in major pelvic vessels. They are not as useful in identifying clots in smaller vessels. In such cases, the ultimate diagnosis may depend upon your response to anticoagulant (blood thinner) medication. An ultrasound examination can also help confirm the diagnosis but is probably not as sensitive as a CT scan or MRI.

How Should this Condition Be Treated?

If you have septic pelvic vein thrombophlebitis, you are treated with intravenous doses of the blood thinner heparin (Lovenox). You have your blood tested to ensure that the dose of heparin is adjusted appropriately. Although most patients improve within 48 to 72 hours, treatment usually lasts for seven to 10 days. It probably won't be necessary to take oral blood thinners-such as warfarin (Coumadin)-for an extended period of time unless you have massive clotting throughout the pelvic vessels or have sustained a pulmonary embolism.

While receiving heparin, you are also treated with broad-spectrum antibiotics such as clindamycin (Cleocin) or metronidazole (Flagyl), plus penicillin (PenVK) or ampicillin (Principen), plus gentamicin (Garamycin).

If your condition does not improve after several days of medication, you may require surgery. Surgical procedures may range from ligation (tying) of the vessel or vessels that contains the blood clot to removal of the infected vessel(s) along with the ovaries, tubes, and uterus.