PMC9260443_01
(A) Perforation of the inferior vena cava (IVC) filter strut anteriorly into the duodenum on an abdominal computed tomography scan (white arrow) (B) Strut protruding into the lumen as seen on esophagogastroduodenoscopy (white arrow) (C) Inferior vena cavagram with the IVC struts outside of the IVC (black arrow).
gr1.jpg
PMC9260443_01_gr1.jpg
fig1
Imaging workup demonstrated perforation of the IVC filter strut into the third part of the duodenum (Fig. 1A) and a dilated 9 mm common bile duct with an ampullary stricture. Esophagogastroduodenoscopy (EGD) revealed an IVC filter strut protruding into the third part of the duodenum with mucosal ulceration and thickening (Fig. 1B). A cavagram was performed, which demonstrated a patent IVC with the struts of the filter outside the lumen (Fig. 1C).
(A) Inferior vena cava (IVC) with duodenocaval fistula. D = duodenum; ROV = right ovarian vein; S = strut (B) Filter as seen through the longitudinal venotomy. F = IVC filter; S = strut (C) Completely removed IVC filter (D) IVC with the filter removed (E) Completed repair with the vein patch angioplasty.
gr2.jpg
PMC9260443_01_gr2.jpg
fig2
Next, the duodenocaval fistula (Fig. 2A) was completely exposed. The fistula was completely transected, and the duodenum was closed in two layers, and the area copiously irrigated with saline (Fig. 2B). The luminal segments of the filter legs, which were encased in dense fibro-intima, were sharply dissected out and the entire filter removed (Fig. 2C). To avoid narrowing, the IVC was repaired with a greater saphenous vein patch angioplasty (Fig. 2D and E).