Acute right lower limb deep venous thrombosis due to pressure from large adenomyotic uterus-laparoscopic management

Acute right lower limb deep venous thrombosis due to pressure from large adenomyotic uterus-laparoscopic management DOI: https://doi.org/10.18203/2320-1770.ijrcog20204850Keywords: Abnormal uterine bleeding, Adenomyosis, DVT, ThrombolysisAbstract A 48-year lady came with abnormal uterine bleeding with 22 weeks size adenomyotic uterus compressing on right common iliac, external iliac and femoral vein leading to acute deep venous thrombosis (DVT). She had history of severe anaemia secondary to menorrhagia with multiple blood transfusions and medical management with tranexamic acid and oral and intrauterine progesterone for 2 years. She presented with right leg swelling and discoloration for 1 day, and a doppler ultrasound confirmed an extensive DVT. Limb saving procedure was taken up immediately with right femoral vein catheterization and venoplasty followed by heparin infusion and thrombolysis for total 48 hours. After 12 hours of stopping heparin drip total laparoscopic hysterectomy was done in view of continuous bleeding and to decrease pressure on iliac vessels. Post-operative heparin infusion started in 8 hours and patient was discharged in stable condition 48 hours post-surgery. Histopathological examination confirmed adenomyosis with weight of specimen being 1.5 kg. Large uterine fibroids are a well-known cause of DVT and/or pulmonary embolism (PE). However, reports of large uterine adenomyosis causing DVT secondary to pelvic compression are scanty. Metrics References Heit JA. Epidemiology of venous thromboembolism, Nat Rev Cardiol. 2015;12(8):464-74. DH Lee, CW Kim, SE Kim. Deep Venous Thrombosis Caused by a Huge Uterine Myoma. Hong Kong J Emergency Med. 2017;19(5):361-3. Ramanan S, Chapman-Wardy J, Watson R. Bleeding versus Clotting: A Complex Case of a Large Fibroid Uterus Causing Menorrhagia and a DVT. Case Rep Obstetr Gynecol. 2016;2016:4. Yin X, Wu J, Song S, Zhang B, Chen Y. Cerebral infarcts associated with adenomyosis: a rare risk factor for stroke in middle-aged women: a case series. BMC Neurol. 2018;18(213). Onur I. Adenomyosis. Pathology Outlines.com website. Oct 8, 2019. Available at: http://www.pathologyoutlines.com/topic/uterusadenomyosis.html. Accessed on 27 July 2020. Rao AS, Konig G, Leers SA, Cho J, Rhee RY, Makaroun MS, et al. (November 2009). "Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis: an alternative in patients with contraindications to thrombolysis". Journal of Vascular Surgery. 50 (5): 1092–8. Ibrahim R, Dashkova I, Williams M, Khanna T, Kozikowski A, Dashkova A et al. Pulmonary embolism secondary to uterine fibroid: A case report of a rare presentation. J Phlebol Lymphol. 2018;11(1):13-5. Garoufalis E. Lower-Extremity DVT Associated with a Large Uterine Leiomyoma, May 18, 2007. https://www.mdmag.com/journals/resident-and-staff/2006/2006-06/2006-06_01. Accessed on 27/7/2020. Yamanaka A, Kimura F, Yoshida T, Kita N, Takahashi K, Kushima R et al. Dysfunctional coagulation and fibrinolysis systems due to adenomyosis is a possible cause of thrombosis and menorrhagia. Eu J Obst Gynecol Reprod Biol. 2016;4:99-103. Akira S, Iwasaki N, Ichikawa M, Mine K, Kuwabara Y, Takeshita T, et al. Successful long-term management of adenomyosis associated with deep thrombosis by low-dose gonadotropin-releasing hormone agonist therapy, Clin Exp Obstet Gynecol. 2009;36(2):123-5.