Pulmonary embolism is the leading cause of non-cancer related mortality in patients with malignancy. While anticoagulation remains the mainstay of treatment, inferior vena cava (IVC) filters are frequently utilised when anticoagulation is contraindicated, particularly in patients undergoing surgical procedures with a high risk of bleeding. Although IVC filters are generally considered safe, there use can be associated with rare but potentially serious complications, including caval wall perforation. Caval wall perforation is a recognised yet frequently underreported complication as fewer than 10% of affected patients are symptomatic. We report a case of perforation of an IVC filter strut through the caval wall, identified intra-operatively during cytoreductive surgery for recurrent pelvic disease in a patient with colorectal cancer. This case, together with the intra-operative images, highlights the recognition of IVC filter–related complications and describes the multidisciplinary decision-making process between the surgical and interventional radiology teams in managing this unusual finding.