Jehangir Asad, Rettew Andrew, Shaikh Bilal, Bennett Kyle, Jehangir Qasim, Qureshi Anam, Arshad Sharjeel, Spiegel Adam
Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
Department of Internal Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan.
Am J Case Rep. 2015 May 16;16:292-5. doi: 10.12659/AJCR.893541.
The number of IVC filter-related complications has increased with their growing utilization; however, IVC filter perforation of the duodenum is rare. It can manifest with nonspecific abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction.
A 67-year-old female presented with several years of right upper quadrant abdominal pain which was exacerbated by movement and food intake. She had a history of hepatic steatosis, cholecystectomy, and multiple DVTs with inferior vena cava filter placement. Physical exam was unremarkable. Laboratory tests demonstrated elevated alkaline phosphatase and transaminases. Esophagogastroduodenoscopy revealed a thin metallic foreign body embedded in the duodenal wall and protruding into the duodenal lumen with surrounding erythema and edema, but no active hemorrhage. Further evaluation with non-contrast CT scan revealed that one of the prongs of her IVC filter had perforated through the vena cava wall into the adjacent duodenum. Exploratory laparotomy was required for removal of the IVC filter and repair of the vena cava and duodenum. Her post-operative course was uneventful.
In patients with history of IVC filter placement with non-specific abdominal pain, a high clinical suspicion of IVC filter perforation of the duodenum should be raised, as diagnosis may be challenging. CT scan and EGD are valuable in the diagnosis. Excellent outcomes have been reported with open surgical filter removal. Low retrieval rates of IVC filters have led to increased complications; hence, early removal should be undertaken as clinically indicated.
随着下腔静脉滤器（IVC filter）使用的增加，其相关并发症的数量也在上升；然而，IVC滤器穿孔进入十二指肠的情况较为罕见。它可能表现为非特异性腹痛、胃肠道出血、腔十二指肠瘘或小肠梗阻。
一名67岁女性因右上腹疼痛数年就诊，运动和进食会使疼痛加剧。她有肝脂肪变性、胆囊切除术史，以及多次深静脉血栓形成并置入了下腔静脉滤器。体格检查无异常。实验室检查显示碱性磷酸酶和转氨酶升高。食管胃十二指肠镜检查发现十二指肠壁内嵌有一个细金属异物，异物突入十二指肠腔，周围有红斑和水肿，但无活动性出血。非增强CT扫描进一步评估显示，她的IVC滤器的一个支脚已穿过腔静脉壁进入相邻的十二指肠。需要进行剖腹探查以取出IVC滤器并修复腔静脉和十二指肠。她的术后过程顺利。
对于有IVC滤器置入史且伴有非特异性腹痛的患者，应高度怀疑IVC滤器穿孔进入十二指肠，因为诊断可能具有挑战性。CT扫描和食管胃十二指肠镜检查在诊断中很有价值。开放手术取出滤器已报告有良好的结果。IVC滤器的低取出率导致并发症增加；因此，应根据临床指征尽早取出。
