2660 Duodenal Perforation Caused by Inferior Vena Cava Migration

Abstract

INTRODUCTION: The Inferior Vena Cava filter is known as an effective method for preventing pulmonary thromboembolism in patients with deep vein thrombosis. Usually, the remaining IVC filters are asymptomatic and do not cause clinical problems. We report two cases of duodenal perforation caused by a remaining IVC filter which is very rare. CASE DESCRIPTION/METHODS: Case 1: 67 year old female patient with past medical history of heartburn,IVC filter placement presented at the GI outpatient clinic with complains of abdominal pain and heartburn for 6 months.After initial negative work up, Upper Endoscopy done showed small polyp at the metallic clip adjacent to the ampulla.Endoscopic ultrasound subsequently revealed a metal object traversing the duodenal wall. No biopsies or additional manipulation of the metal object were done until we did a CT scan which showed two distal anterior legs of the IVC filter extending into the transverse duodenum.This patient was referred to vascular surgeon for IVC filter removal but the patient's symptoms started resolving and after discussion with the patient it was decided not to proceed with the surgery and manage her conservatively. CASE 2: 37 y/o female seen in GI clinic for repeated episodes of nausea, vomiting, and abdominal discomfort which had been going on for 4 months and after negative initial work up, patient was scheduled for an Upper endoscopy which showed a metal like foreign body in the second portion of the duodenum and irritation of the opposite wall of the second portion of the duodenum with nodularity and represented a prong of the IVC filter which migrated into duodenum.Patient was referred to vascular surgeon for IVC filter removal and after the procedure post operatively she was kept on intravenous antibiotics and was discharged after she was able to tolerate regulate diet and was ambulating well. DISCUSSION: IVC filter perforation of the duodenum is fairly uncommon. It can manifest with abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction. Diagnostic evaluation include plain abdominal radiographs, CT scan and/or Upper Endoscopy.To prevent potential sequelae caused by IVC filter leg penetration, like that reported in this case, the removal of the IVC filter, when possible, is preferred.Also manipulations of the foreign body should be avoided until further confirmation is done by abdominal imaging.