Our Summary

This paper presents the case of a patient who had a specific type of filter placed in a major vein (the inferior vena cava or IVC) that unexpectedly punctured the vein’s wall. This happened after the patient underwent a complex surgery (Whipple’s procedure) for a type of cancer found in a part of the digestive system (ampullary carcinoma). The puncture from the filter caused injury and blockage to the tube (ureter) that carries urine from the kidney to the bladder. This led to a build-up of urine in the kidney and the ureter, conditions known as hydronephrosis and hydroureter respectively.

This issue was only discovered during a routine follow-up scan after the surgery. To fix the problem, the researchers removed the filter from the vein and placed a special tube (nephrostomy catheter) to unblock the ureter.

This case emphasises the need for surgeons to be extremely careful when handling the IVC during abdominal surgery if a filter is present. It also suggests that, unless the filter is needed to prevent blood clots from travelling during the surgery, it may be better to temporarily remove the filter and reinsert it after the operation to avoid such complications.

FAQs

  1. What is a Whipple’s pancreatico-duodenectomy procedure and why is it performed?
  2. What complications can occur as a result of an indwelling inferior vena cava filter during a Whipple procedure?
  3. What measures can be taken to prevent complications such as ureteral injury and obstruction during a Whipple procedure?

Doctor’s Tip

A doctor might tell a patient undergoing a Whipple procedure to inform their surgical team if they have an indwelling inferior vena cava filter, as it can increase the risk of complications such as ureteral injury. It may be necessary to temporarily remove the filter during the surgery to prevent such complications. It is important to carefully discuss any existing medical devices or conditions with your healthcare team before undergoing surgery.

Suitable For

Patients who are typically recommended to undergo a Whipple procedure include those with:

  1. Pancreatic cancer
  2. Ampullary carcinoma
  3. Distal common bile duct cancer
  4. Chronic pancreatitis with severe complications
  5. Neuroendocrine tumors of the pancreas
  6. Benign tumors of the pancreas or duodenum that cannot be removed by other means

It is important for patients to undergo a thorough evaluation by a multidisciplinary team of specialists to determine if they are suitable candidates for a Whipple procedure. Additionally, patients with a history of inferior vena cava filter placement should be carefully evaluated and monitored during and after the surgery to prevent potential complications such as the one described in the case report.

Timeline

Before the Whipple procedure:

  • Patient is diagnosed with ampullary carcinoma
  • Consults with surgeon to discuss treatment options
  • Prepares for surgery by undergoing imaging tests and blood work
  • Receives instructions on pre-operative care and diet restrictions

After the Whipple procedure:

  • Patient undergoes post-operative care in the hospital for monitoring and pain management
  • Begins a gradual recovery process, including physical therapy and dietary adjustments
  • Follows up with surgeon for monitoring of incision healing and overall health
  • Undergoes imaging tests for routine follow up and evaluation of surgical results
  • Incidentally discovers penetration of IVC filter into IVC wall, resulting in right ureteral injury and obstruction
  • Retrieves IVC filter and places nephrostomy catheter to relieve ureteral obstruction
  • Continues follow up care and monitoring for potential complications or further treatment needs.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a Whipple procedure, particularly in my case?
  2. How long is the recovery process expected to be after the Whipple procedure?
  3. Will I need any additional procedures or treatments after the Whipple procedure?
  4. How will the Whipple procedure specifically impact my digestive system and ability to eat?
  5. What kind of follow-up care will be necessary after the Whipple procedure?
  6. How often will I need to have imaging or tests done to monitor for any complications?
  7. Are there any specific precautions I should take or lifestyle changes I should make after the Whipple procedure?
  8. What are the chances of experiencing complications related to the inferior vena cava filter during the Whipple procedure?
  9. Are there any alternative treatment options to consider instead of the Whipple procedure?
  10. What is the success rate of the Whipple procedure in patients with my specific condition?

Reference

Authors: Abdel-Aal AK, Ezzeldin IB, Moustafa AS, Ertel N, Oser R. Journal: J Radiol Case Rep. 2015 Dec 31;9(12):37-43. doi: 10.3941/jrcr.v9i12.2508. eCollection 2015 Dec. PMID: 27200175