title: Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury.
abstract: We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple's pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure.
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA.
authors.forename: Ahmed Kamel
authors.initials: AK
authors.lastname: Abdel-Aal
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA.
authors.forename: Islam B
authors.initials: IB
authors.lastname: Ezzeldin
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA.
authors.forename: Amr Soliman
authors.initials: AS
authors.lastname: Moustafa
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ertel
authors.affiliation: Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Oser
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020878:Device Removal; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000293:injuries*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology*; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000293:injuries*
keywords: Hydronephrosis; Hydroureter; IVC filter; Ureteral injury; Whipple procedure; penetration