Duodenal Perforation due to Inferior Vena Cava Filter in a Multi-morbid Young Patient: First Clinical Case Report in Latvia

ABSTRACT
Introduction: The inferior vena cava filter is known to be a safe and effective method for preventing fatal pulmonary
artery thromboembolism. We report a case report of inferior vena cava filter perforation on duodenum in a
multimorbid young patient undergoing full midline laparotomy and cavotomy.
Case presentation: A 37-year-old male was admitted to a tertiary university hospital following recurrent episodes of
epistaxis. In 2008, the patient developed traumatic subarachnoid haemorrhage with a following decompressive
trepanation and bilateral pulmonary artery thromboembolism. An inferior vena cava filter was implanted. In 2021,
due to suspected duodenal perforation, an urgent fibrogastroscopy was performed, revealing duodenal perforation
caused by the inferior vena cava filter and aortic pseudoaneurysm. Vena cava filter evacuation was indicated; to date,
no such operation has been performed in Latvia. The early postoperative period occurred without any complications.
The patient was discharged 15 days after the surgical treatment in good overall health.
Results: This was a clinical case report about a 37-year-old multimorbid patient with positive anamnesis of traumatic
subarachnoid haemorrhage following decompressive trepanation and bilateral pulmonary artery thromboembolism
and inferior vena cava filter implantation due to absolute contraindications to anticoagulant therapy.
Conclusion: Inferior vena cava filters are generally safe but can cause clinically significant complications. The case of
37-year-old multimorbid patient with the main complaints of pain around the left ear and recurrent nose bleeds was
discussed. On fibrogastroscopy, duodenal perforation caused by the inferior vena cava filter and aortic
pseudoaneurysm were seen. Full midline laparotomy and cavotomy was performed. The patient was discharged in
good overall health. Detailed assessment of the radiological findings, fibrogastroscopic studies and the novel
treatment of a complicated disease occurring for the first time in Latvia proved successful for both patient recovery
and outcome.
Keywords: Cavotomy; Laparotomy; Multimorbidity; Inferior vena cava filter; Duodenal perforation