P2440 - Inferior Vena Cava Filter Perforation Into the Duodenum: A Possible Etiology of Epigastric Pain

Mikaela Lipp, ¹, Robert Klein, MD, FACG², Keith Sultan, MD, FACG^3
1Duke University, Great Neck, NY; ²Zucker School of Medicine Hofstra University, Garden City, NY; ³Northwell Health, Manhasset, NY

Introduction: Epigastric pain is among the most common complaints encountered by gastroenterologists and one of the most common indications for upper endoscopy (EGD). Likewise, inferior vena cava (IVC) filters are commonly placed to prevent pulmonary embolism in patients with venous thromboembolism who have a contraindication to anticoagulation. Thousands of IVC filters are placed annually in the United States¹ with a rate of major complications estimated at only .03%². We present a case of duodenal perforation from an IVC filter presenting with epigastric pain.

Case Description/Methods: A 49-year-old woman with a history of IVC filter placement 15 years earlier for a deep vein thrombosis during pregnancy presented with epigastric pain. She had gone to the ER one week previously after experiencing pain for three days. An abdominal ultrasound and LFTs were normal. She was given famotidine in the ER with some improvement and was discharged. The pain persisted and an EGD was performed, which showed a metallic foreign body in the second portion of the duodenum (Figure 1). The patient was hospitalized, and a CT demonstrated that a flange of the IVC filter had perforated into the duodenum (Figure 2). The filter was removed surgically, and the patient has had no further epigastric pain.

Discussion: There have been few published case reports of duodenal perforation by IVC filters, most of which appear in the surgical and radiological literature. Some patients presented with abdominal pain, while others reported hematemesis, melena, and back pain. References that list causes of epigastric pain typically do not mention this important complication. Though our patients’ diagnosis was made quickly, it was unexpected, and further delay could have been associated with a poor outcome. Our experience reinforces the continued importance of a thorough patient history and awareness of this rare but potentially severe complication. Gastroenterologists need to be more cognizant of the possibility that IVC filters placed even years previously can perforate into the duodenum, and this should be included in the differential diagnosis of epigastric pain.

References:

1. Ahmed O, Wadhwa V, Patel K, Patel M, Turba U, Arslan B; J Am Coll Radiol 2018; 15:1553-57

2. Athanasoulis C, Kaufman J, Halpern E, Waltman A, Geller S, Fan C; Radiology 2000; 216:54-66



Disclosures:


Mikaela Lipp, ¹, Robert Klein, MD, FACG², Keith Sultan, MD, FACG³. P2440 - Inferior Vena Cava Filter Perforation Into the Duodenum: A Possible Etiology of Epigastric Pain, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.