Pulmonary Thromboembolism Secondary to Ovarian Vein Thrombosis in a Patient With Left-Sided Inferior Vena Cava Following Laparoscopic Gallbladder Bed Resection

Left-sided inferior vena cava (IVC) is a rare vascular anomaly that can alter venous hemodynamics and potentially increase the risk of deep vein thrombosis and pulmonary thromboembolism (PTE). Ovarian vein thrombosis (OVT) is typically associated with obstetric or gynecologic conditions and is rarely reported as a complication of gastrointestinal surgery. Here, we report a unique case of PTE resulting from OVT in a patient with left-sided IVC who underwent laparoscopic gallbladder bed resection. A 79-year-old woman with a preoperative diagnosis of left-sided IVC was under surveillance for gallbladder adenomyomatosis. Due to progressive gallbladder wall thickening and suspected carcinoma, she underwent laparoscopic gallbladder bed resection. The procedure included station #16b1 lymph node sampling, during which the right ovarian vein could not be identified. The operation was performed in the reverse Trendelenburg position and lasted 268 min. On postoperative day five, routine contrast-enhanced computed tomography (CT) revealed a right OVT and subsequent PTE. The patient was promptly treated with anticoagulation therapy, initially with heparin followed by rivaroxaban. She was discharged on postoperative day 13 without further complications. A pre-discharge CT scan showed improvement in the PTE, although the OVT remained largely unchanged. Final pathological examination revealed a benign hyperplastic polyp and adenomyomatosis. This rare case suggests that left-sided IVC may predispose patients to postoperative thrombotic complications, such as OVT, leading to PTE even after minimally invasive abdominal surgery. This underscores the importance of meticulous preoperative vascular assessments to identify anatomical variations. Furthermore, heightened clinical vigilance for venous thromboembolism, including OVT, is warranted in such patients. Postoperative thromboprophylaxis may be prudent in this population. This case highlights a novel association between left-sided IVC, OVT, and PTE in the context of gastrointestinal surgery.