Multiorgan and vena cava perforation by an inferior vena cava filter: surgical approach and bovine pericardial patch reconstruction

A 64-year-old man with history of pulmonary embolism placed about 30 years back an inferior vena cava (IVC) filter. Computed tomography (CT) scan incidentally revealed the penetration of the IVC filter struts through the wall of the IVC and duodenum (Panel A). Esophagogastroduodenoscopy (EGD) showed two metallic foreign bodies protruding from the second portion of the duodenal wall (Panel B). The patient was asymptomatic. After multi-disciplinary discussion, an exploratory laparotomy was planned in order to remove the filter and to repair IVC and duodenum. Surgical exposure was performed through a xipho-pubic laparotomy. Although it was difficult to mobilize the duodenum due to adhesion resulting from inflammation of the surrounding soft tissues, the duodenum was reflexed with the Kocher manoeuver. Dissection of retroperitoneum revealed the IVC filter struts perforating the vein wall in multiple directions, the duodenal serosa, and the head of the pancreas (Panel C...