P1491 - Duodenal Perforation by an IVC Filter

Ameer Halim, MD, Ahmed Chatila, MD, Dania Hudhud, MD, Jennifer Wellington, DO, Seema Patil, MD
University of Maryland School of Medicine, Baltimore, MD

Introduction: Inferior Vena Cava (IVC) filters have safely been used in patients with contraindications to anticoagulation in preventing pulmonary embolisms since the 1970s, but they do carry with them risk of complications including erosion into surrounding structures, embolization, and migration. We present 2 distinct cases of perforated IVC filters in the duodenum which both patients presenting with ongoing symptoms, endoscopic confirmation for diagnosis, and operative management, retrieval of the filter, and repair of the perforation.

Case Description/Methods: A 28 year old female with a past medical history of intravenous drug use, multiple deep vein thrombi status-post IVC filter, and recurrent admissions for anemia requiring transfusions presented to the emergency room with abdominal pain and altered mental status. An EGD done shortly after showed hematin in the gastric antrum, fundus, and body, a Forrest Class III 5-cm gastric ulcer, and a duodenal perforation secondary to IVC filter erosion and puncture of the 2nd portion of the duodenum (Image 1 and 2). The patient was taken to the operating room for successful removal of the IVC filter and repair of the duodenal perforation.

A 55 year old male with a past medical history of right inguinal hernia repair in 1992 followed by deep vein thrombus development and subsequent IVC filter placement presented to the emergency room for abdominal pain starting about one week ago. An EGD was done for assessment of abdominal pain and concern for IVC filter penetration into the duodenum. EGD showed mild gastritis and duodenal foreign body seen in the medial wall of the second portion of the duodenum (Image 3 and 4). The patient was taken back to the operating room for a successful removal of the IVC filter and repair of the duodenal perforation.

Discussion: We present 2 distinct cases of symptomatic perforated IVC filters in the duodenum which both resulted in operative management, retrieval of the filter, and repair of the perforation. The perforations were visualized thru EGD with surgical intervention sought after for endovascular filter retrieval and surgical repair of the perforation. These cases demonstrate it remains imperative that providers with patients who have an IVC filter in place consider duodenal perforation on the differential in patients presenting with similar symptoms in order to allow for timely and safe management.


Figure: Image 1. Forrest Class III 5-cm gastric ulcer (Case 1)
Image 2. IVC filter erosion and puncture of the 2nd portion of the duodenum (Case 1)
Image 3. IVC filter puncture of the 2nd portion of the duodenum (Case 2)
Image 4. IVC filter puncture of the 2nd portion of the duodenum (Alternative View) (Case 2)


Disclosures:
Ameer Halim indicated no relevant financial relationships.
Ahmed Chatila indicated no relevant financial relationships.
Dania Hudhud indicated no relevant financial relationships.
Jennifer Wellington indicated no relevant financial relationships.
Seema Patil indicated no relevant financial relationships.


Ameer Halim, MD, Ahmed Chatila, MD, Dania Hudhud, MD, Jennifer Wellington, DO, Seema Patil, MD. P1491 - Duodenal Perforation by an IVC Filter, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.