P4155 - Inferior Vena Cava Filter Penetrating the Duodenum: A Rare Complication

Sara Stanley, DO¹, Ali Heif, ², Anas Renno, MD¹, Tetyana Kulish, ³, Muhammad Aziz, MD¹, Muhannad Heif, MD^4
1University of Toledo, Toledo, OH; ²St. John’s Jesuit High School, Toledo, OH; ³Wayne State University, Detroit, MI; ⁴University of Toledo, Promedica Healthcare System, Toledo, OH

Introduction: Inferior vena cava (IVC) filters are an effective therapy for patients who have contraindications to anticoagulation. A late complication of IVC filters is erosion of the filter legs through the IVC wall into surrounding structures, such as the duodenum leading to small bowel perforation or gastrointestinal bleeding. It is important to recognize this late complication in the differential diagnosis in patients with history of IVC filter presenting with abdominal pain.

Case Description/Methods: 59-year-old male with history of alcohol-induced pancreatitis presented to the clinic for eight months of non-specific intermittent epigastric abdominal pain. Patient has a surgical history of pelvic reconstruction after a motor vehicle accident in 1990 with placement of a stainless-steel Greenfield IVC filter for PE prophylaxis. Laboratory studies were unremarkable except for mildly elevated lipase and amylase at 86 and 113, respectively. CT abdomen and MRCP revealed small incidental pancreatic cysts. An EGD was performed and revealed a metallic foreign body embedded in the wall of the third part of the duodenum. Removal was not attempted. To further investigate this foreign body, a repeat CT abdomen was performed and confirmed erosion of the IVC filter legs into the duodenum. Comparison with previous imaging from 2003 revealed unchanged filter penetration into the duodenum. The risks and benefits of surgical intervention were discussed with the patient who preferred continued observation.

Discussion: Inferior vena cava filters can cause a myriad of late complications, one of which is penetration through the wall of the IVC into surrounding structures. Fortunately, this is a rare adverse event, with 4.4% reported occurrence with the stainless-steel Greenfield filters. CT scan and MRCP were performed prior to endoscopy, however the eroded IVC filter was not mentioned in these reports. Thus, it is important to recognize this complication, as these eroded filters may first be noted during endoscopy, as it was in this case. Given the delicacy of surrounding structures, attempting endoscopic removal of an unknown foreign body could be detrimental and further imaging studies should be obtained to determine the etiology and assess involvement of nearby structures. There are some instances when these filters are found incidentally in asymptomatic patients and observation can be recommended, however symptomatic patients should be referred for surgical evaluation.



Disclosures:


Sara Stanley, DO¹, Ali Heif, ², Anas Renno, MD¹, Tetyana Kulish, ³, Muhammad Aziz, MD¹, Muhannad Heif, MD⁴. P4155 - Inferior Vena Cava Filter Penetrating the Duodenum: A Rare Complication, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.