Diagnostic pitfalls in the postpartum period: postpartum ovarian vein thrombosis misdiagnosed as appendicitis

A woman presented 20 days postpartum to a tertiary hospital emergency department with right iliac fossa pain, nausea and anorexia. CT imaging suggested appendicitis and she was scheduled for laparoscopic appendicectomy. An inflamed right infundibulopelvic ligament was identified intraoperatively instead indicating ovarian vein thrombophlebitis. She was treated with short-term intravenous antibiotics and therapeutic enoxaparin for 3 months.This case highlights the diagnostic challenge of postpartum ovarian vein thrombosis (POVT), a rare but potentially serious condition that can mimic appendicitis. POVT may be difficult to discern on CT scan despite it being the primary diagnostic tool in the acute setting. Clinical suspicion must remain high in postpartum women with abdominal pain, especially in the context of risk factors such as caesarean section, multiple pregnancy, uterine infections, preeclampsia and elevated body mass index. Early recognition may avoid unnecessary surgery, prevent complications such as pulmonary embolism and enable timely initiation of anticoagulation therapy.