Autopsy findings of inferior vena cava filter perforation: a forensic analysis of retroperitoneal hemorrhage and medical liability.

The inferior vena cava filter (IVCF) reduces the risk of fatal pulmonary embolism but carries risks of severe complications. A 63-year-old hypertensive female with lower-extremity deep vein thrombosis underwent IVCF placement and anticoagulation. On postoperative day 9, the patient developed sudden nausea and abdominal distension, which progressed rapidly to hemorrhagic shock and death. This led to lawsuits for medical malpractice. Autopsy revealed IVCF migration and perforation, which caused inferior vena cava (IVC) perforation and retroperitoneal hematoma. Hemorrhagic shock was confirmed as the cause of death by autopsy and histopathological analysis. Anticoagulation plausibly increased bleeding, whereas hypertension masked early signs of hypotension. This fatal case highlights the critical need for vigilance toward atypical postoperative symptoms (e.g., abdominal distension) and mandates rigorous imaging surveillance (e.g., early computed tomography (CT) angiography) and coagulation monitoring to prevent lethal complications. Autopsy can clarify the cause of death, inform clinical risk management, and promote medicolegal resolution.