Laparoscopic treatment of ovarian

vein syndrome – case report

Pirtea L, Pirtea M, Grigoras D, Sas I,

Balta G, Balan L, Craciun G, Motoc A

UMF Victor Babes Timisoara

 Definition
• Ovarian vein syndrome (OVS) is a rare condition classified as
a form of pelvic congestion syndrome, caused by varicose,
dilated ovarian veins.
• The most common clinical sign is persistent abdominal pain
that has no other cause.
• Typically, OVS occurs in thin females with a right-sided
predilection.
Pathogenesis
• OVS was first reported by Clark in 1964. Few
cases have since been reported
• The mechanism is represented by the dilatation
of ovarian veins induced by pelvic congestion or
an enlarged uterus during pregnancy that can
cause the compression of the ureter.
• Hodgkinson, Southwell and Bourne suggested
that substantially increased venous pressure
causes dilation of the ovarian veins and
compresses the ureter thus resulting in OVS.
Symptoms
• The major clinical symptoms include lower back
pain, lower abdominal and pelvic pain,
dysmenorrhea, dysuria, urinary frequency and
urgency, constant urinary requirements, gross
hematuria and renal colic.
• The presence of chronic ureteral obstruction,
urinary infection, and calculi may occur repeatedly
in patients, resulting in patients suffering from the
disease for a long period of time, requiring several
surgical procedures, or developing renal
dysfunction.
Diagnosis
• OVS is difficult to diagnose.
• Currently, the most
important diagnostic
method is imaging
examination.
• To date, limited studies
have reported the diagnosis
of OVS.
Imaging
• OVS can be diagnosed by
▫ venography
▫ Doppler ultrasound
▫ CT imaging
▫ MRI
• In general, ovarian vein enlargement is defined
as a an ovarian vein diameter ≥7 mm or >8 mm.
• Diagnostic criteria for CT scanning in the
diagnosis of PCS proposed by Coakley et al
includes: the existence of ipsilateral parauterine
veins with at least 4 different diameters, or at
least 1 of the veins with a diameter >4 mm; or
the diameter of the ovarian vein >8 mm.
Case report
• 38 years old patient referred to our clinic with
persistent abdominal pain
Venography - blood reflux in both ovarian
veins was demonstrated
• video
Outcome
• By using a laparoscopic approach, the ureter and
obstructing vessel were readily identified to
effectively treat the patient.
• The patient recovered well and reported
significant improvement after surgery
• The patient was reassessed at 3 months after
surgery and reported complete regression of the
abdominal pain
Conclusions
• OVS is rare disease, that can cause chronic pelvic
pain and urinary tract symptoms
• treatment options for OVS:
▫ ovarian vein embolisation
▫ surgical treatment:
 The traditional treatment for this condition has been
open excision of the ovarian vein and ureterolysis
 Laparoscopic treatment - provides a better
assessment of the periureteral anatomy and
identification of the ovarian vein, offering the well
known benefits of minimally invasive surgery
Thank you!