Aim: To report the first case of a Bird's Nest IVC filter causing a chronic pain syndrome lasting 13 years through IVC wall penetration and subsequent break off of one of the filter struts.
Materials and results: A 43-year-old female presented with a 13-year history of abdominal pain following uneventful insertion of a Bird's Nest vena cava filter through a right internal jugular percutaneous approach. A year following the procedure, CT scan revealed one arm of the filter to be outside IVC borders. Nine years from the date of insertion the nature of the pain changed acutely following a five feet jump to more localized RUQ pain worse with twisting movements. A CT scan showed the strut to have pierced the IVC wall and penetrated the Unicate process of pancreas. Plain x-rays taken at different times in February 2006 showed one of the struts to be free floating in the peritoneal cavity. The floating strut was removed surgically from the wall of the Ileum. Postoperative recovery was uneventful and the patient was discharged pain free three days later.
Conclusion: Chronic pain is an added complication of BNF devices. Although rare, it further emphasizes the need for long-term follow up of patients with IVC filters.