Septic Pelvic Thrombophlebitis Status Post-Laparoscopic Hysterectomy: A Case Report Investigating a Rare Yet Perilous Adverse Outcome

Septic pelvic thrombophlebitis is defined as an endovascular thrombus of infectious etiology. It is frequently diagnosed only after excluding other more common pathologies. A high level of suspicion should be maintained in the context of a fever refractory to broad-spectrum antibiotics that improves after initiation of systemic anticoagulation. The risk of thromboembolic events following minimally invasive surgery is minute; however, it requires increased awareness, as prompt management is critical for decreasing morbidity and mortality. We discuss a case of septic thrombophlebitis in a 42-year-old female who was postoperative day six status post elective total laparoscopic hysterectomy, bilateral salpingectomy, and right ovarian cystectomy due to abnormal uterine bleeding. The case was complicated by a postoperatively diagnosed small bowel injury that necessitated resection. The patient continued to exhibit a fever of unknown origin despite the administration of broad-spectrum antibiotics; therefore, CT imaging with IV contrast was obtained. The imaging raised concerns about septic thrombophlebitis, and the symptoms were resolved with the administration of a 16-hour infusion of intravenous heparin. Despite its rarity, septic pelvic thrombophlebitis should be considered in patients with relevant risk factors and persistent fever refractory to antibiotics status post-laparoscopy. This report highlights the importance of awareness of SPT and encourages further research on thromboembolic events in laparoscopic surgeries.