Duodenal perforation by an inferior vena cava filter with staphylococcal bacteremia: a case report
Sunil Pokharel1, Catherine Bartholomew2, Zing Zau3
1Department of Medicine, Albany Medical Center, 47 New Scotland Avenue, Mail Code 17, Albany, NY, 12208, USA. pokhars@mail.amc.edu.
Background:
Inferior vena cava filter complications can range from dislodgement to perforation. Patients who present with concomitant bacteremia have rarely been reported. Persistent bacteremia usually results from direct bacterial seeding from a source other than perforation of surrounding viscus. It is unclear if the risk of perforation is higher in patients who are bacteremic due to other causes.
Case Presentation:
We report an interesting case of a 67-year-old white woman who presented with fever, chills, and right upper quadrant abdominal pain. Her blood cultures were positive for methicillin-sensitive Staphylococcus aureus with no obvious source. Upon further investigation, she was found to have an inferior vena cava filter perforating her duodenum. The cause of her abdominal pain was explained by the inferior vena cava filter penetrating the duodenum; however, the source of bacteremia could not be ascertained. The inferior vena cava filter was removed successfully, and she was discharged on an intravenous antibiotic. Her symptoms resolved soon after the filter was removed.
Conclusions:
The use of inferior vena cava filters has increased significantly in recent years. This is likely due to their wider availability and safer placement techniques. With increasing use, the complications arising from these filters have been on the rise as well. It is very important for clinicians to be aware of these complications to avoid delays in diagnosis and patient care.
Insights
Inferior vena cava (IVC) filters can cause rare duodenal perforations, even with concurrent bacteremia. Prompt IVC filter removal and antibiotics resolved symptoms in a patient with Staphylococcus aureus bacteremia and a perforated duodenum.
Area of Science:
- Vascular surgery
- Gastroenterology
- Infectious disease
Background:
- Inferior vena cava (IVC) filters are increasingly used, leading to a rise in complications like dislodgement and perforation.
- Concomitant bacteremia with IVC filter complications is rare, with unclear links to perforation risk.
Observation:
- A 67-year-old woman presented with fever, RUQ pain, and Staphylococcus aureus bacteremia of unknown origin.
- Imaging revealed an IVC filter perforating the duodenum, explaining her abdominal pain.
Findings:
- Successful removal of the IVC filter and a course of intravenous antibiotics led to symptom resolution.
- The source of bacteremia remained undetermined despite the duodenal perforation.
Implications:
- Clinicians must maintain high awareness of IVC filter complications, including rare presentations like duodenal perforation.
- Early diagnosis and management are crucial for improving patient outcomes in cases of IVC filter-related injuries.
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