The case is about a young female who by c section delivered twins. The lady presented ascites – immune to empirical antibiotic and diuretic therapy – on the 4th postoperative day. The woman was a Turner’s (XO) mosaic, who conceived oocyte donation through Assisted Reproduction Techniques (ART) – IVF – and had a medical history of chronic use of hormonal medicine since puberty. There is a need to exclude thrombophilia, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria. Obstruction of the liver outflow (Budd Chiari syndrome) or inflow (portal vein thrombosis) and small sinusoidal thrombosis can result in hypertension of the portal and ascites. The diagnosis can be aided by CT angiography, perfusion tests using contrast and Doppler studies. The key treatment is the proper, “aggressive” anticoagulation. In the case of post-operative peritoneal fluid accumulation, surgical causes have to be primarily omitted. Furthermore, pregnancy is a hyperdynamic hypercoagulative disorder in which potential pre-existing diseases may come to the surface and lead to morbidity. High suspicion of hepatic vasculature clot formation is paramount, especially in the case of a history of hormone therapy.

Author(s) Details

Nikolaos Tsagka
General Hospital of Lefkas, Greece.

Michail Billis
General Hospital of Lefkas, Greece.

Kostantinos Chalatsis
General Hospital of Lefkas, Greece.

Panagiotis Georgopoulos
General Hospital of Lefkas, Greece.

Athanasios Zikopoulos
Royal Cornwall Hospitals NHS Foundation Trust, Truro, UK.

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