Septic pelvic thrombophlebitis following laparoscopic hysterectomy.
BACKGROUND
The diagnosis of septic pelvic thrombophlebitis is frequently one of exclusion; a suspicion should arise when fever fails to respond to standard broad-spectrum antibiotic therapy and defervesces within 48 hours of the addition of systemic anticoagulation. The risk of a thromboembolic event following minimally invasive surgery is not well defined.


METHODS
We report the first case of septic pelvic thrombophlebitis following laparoscopic hysterectomy in a 51-year-old woman who developed fever on postoperative day 4. The fever workup was negative. The patient's temperature spikes were unresponsive to medical management. A clinical diagnosis of septic pelvic thrombophlebitis was made, and the patient responded excellently to anticoagulation in conjunction with antibiotic therapy.


CONCLUSIONS
Although rare, septic pelvic thrombophlebitis should be suspected after laparoscopy in patients with appropriate risk factors and persistent fever despite antibiotic therapy. Considerable benefit will be derived from clinical trials that study and provide data on the risk and incidence of thromboembolism after laparoscopic procedures.
Center for Special Minimally Invasive Surgery, Palo Alto, California, USA.
Camran
C
Nezhat
Parastoo
P
Farhady
Madeleine
M
Lemyre
D000925:Anticoagulants / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis / Q000188:drug therapy*; D013924:Thrombophlebitis / Q000175:diagnosis / Q000188:drug therapy*
D000925:Anticoagulants