Persistent Abdominal Pain Caused by an Inferior Vena Cava Filter Protruding Into the Duodenum and the Aortic Wall

Malgor, Rafael D.; Hines, George L.; Terrana, Lisa; Labropoulos, Nicos

doi:10.1016/j.avsg.2011.11.038

Cited by 13 publications

(19 citation statements)

References 18 publications

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“… 1 , 2 These perforations are exceedingly rare and usually symptomatic. 3 Existing literature describes cases of symptomatic duodenal perforations from IVC filters managed by surgical procedures. 2 However, there is a paucity of literature on the treatment of asymptomatic penetrations.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Duodenal Perforation from an Inferior Vena Cava Filter

Park

Oza

Krishna

2014

ACG Case Reports Journal

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Recent exponential increase in inferior vena cava (IVC) filter placements has led to a higher rate of filter complications. A 46-year-old man with a past history of IVC filter placement for bilateral deep vein thrombosis presented with lower abdominal pain. Imaging studies demonstrated IVC filter strut penetrations into multiple structures. Upper endoscopy confirmed an uncomplicated single IVC filter strut penetration into the duodenal wall. The abdominal pain was determined to be unrelated to IVC filter strut penetration, and the patient was managed conservatively. Although IVC filter strut penetrations can cause significant complications, current guidelines remain unclear for management of asymptomatic enteric IVC filter strut penetrations.

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Section: Introductionmentioning

confidence: 99%

Asymptomatic Duodenal Perforation from an Inferior Vena Cava Filter

Park

Oza

Krishna

2014

ACG Case Reports Journal

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“… 10 – 12 While caval penetration is often identified as an incidental finding on imaging, it can cause serious complications including acute or chronic pain, hemodynamic instability, bowel perforation, and pancreatitis. 5 , 7 , 11 , 13 – 17 In our patient, persistent abdominal and back pain raised clinical suspicion for filter migration and extension outside the cava wall. CT and fluoroscopic imaging revealed nearly 90° filter tilt and extension of the filter apex through the wall of the cava with abutment of the duodenum, with the barbed filter prongs penetrating the caval wall, abutting retroperitoneal soft tissue structures and the aorta.…”

Section: Discussionmentioning

confidence: 64%

“…Although perforation of the duodenum was not demonstrated, filter adherence to the serosa of the duodenum may have been responsible for her persistent pain. 5 Certainly, intraoperative upper esophagogastroduodenoscopy (EGD) has been utilized as an adjunctive diagnostic maneuver in prior reports of filter penetration through the duodenum, oftentimes visualizing a prong of the filter penetrating through the wall of the duodenum into the lumen itself. 5 , 15 , 16 , 21 We opted not to perform this maneuver as there was good duodenal visualization with the laparoscope after Kocherization.…”

Section: Discussionmentioning

confidence: 99%

“…Perforation/penetration of visceral structures can present with abdominal or back pain, with or without an acute abdomen. 5 – 7 Unfortunately, a tilted IVC filter with the tip embedded in the cava wall can be difficult to retrieve via a standard endovascular approach, since the apex of the filter cannot be easily grasped. While leaving a malpositioned retrievable filter in place as a permanent filter is acceptable in some cases, the clinical situation may dictate more aggressive attempts at filter retrieval to include an open surgical procedure in rare instances.…”

Section: Introductionmentioning

confidence: 99%

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Total laparoscopic retrieval of inferior vena cava filter

Benrashid

Adkar

Bennett

et al. 2015

SAGE Open Medical Case Reports

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While there is some local variability in the use of inferior vena cava filters and there has been some evolution in the indications for filter placement over time, inferior vena cava filters remain a standard option for pulmonary embolism prophylaxis. Indications are clear in certain subpopulations of patients, particularly those with deep venous thrombosis and absolute contraindications to anticoagulation. There are, however, a variety of reported inferior vena cava filter complications in the short and long term, making retrieval of the filter desirable in most cases. Here, we present the case of a morbidly obese patient complaining of chronic abdominal pain after inferior vena cava filter placement and malposition of the filter with extensive protrusion outside the inferior vena cava. She underwent successful laparoscopic retrieval of her malpositioned inferior vena cava filters after failure of a conventional endovascular approach.

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“…Previous case reports suggest treatment with open surgical interventions for symptomatic GI complications, given the degree of inflammation generated at the site of penetration with uncertain retrieval potential and ability of the perforation of the viscus to seal. 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] We have presented a unique cohort of patients with symptomatic GI complications secondary to retrievable filters to better describe management strategies, particularly endovascular retrieval.…”

Section: Discussionmentioning

confidence: 99%