A mysterious journey of a cardiac pacemaker

Manikoth, Prakash; Qora, Hamed T.; Sajwani, Mohammed Jaffer; Valliattu, John; Pawar, Nikunj; Murali, V

doi:10.1016/j.ijcard.2005.01.054

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…In one case, the pacemaker had eroded through the parietal peritoneum and into large bowel and had passed through the rectum; in a second case, the pacemaker was found floating inside the peritoneum cavity at laparotomy. 1,2 In both cases, the time from cardiac pacemaker insertion to symptoms was nearly 2 years.…”

Section: Discussionmentioning

confidence: 92%

A rare cause of abdominal pain

Khwaja²,

Hayat³

et al. 2007

Ann R Coll Surg Engl

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A 60-year-old Caucasian female presented with a 3-day history of right lower quadrant abdominal pain, vomiting and pyrexia.She had a past medical history of congenital aortic stenosis complicated by aortic regurgitation for which she underwent aortic valve replacement (AVR) at Harefield Hospital with a fresh homograft in 1990. She developed third-degree heart block following the valve replacement and, thus, an endocardial pacemaker was inserted. Ten months prior to her current admission, the homograft was replaced with a metallic AVR due to worsening symptoms of cardiac failure and an epicardial pacemaker was inserted deep to the posterior rectus sheath in the epigastric region. This epicardial pacemaker would only be activated once the endocardial pacemaker loses function. Her only medication on admission was warfarin.On examination, her blood pressure was 153/96 mmHg, pulse was 95 beats/min in sinus rhythm and her oxygen saturations was 98% on air. She was pyrexial with a temperature of 37.5°C. Her cardiorespiratory examination was unremarkable. Abdominal examination revealed tenderness in the right iliac fossa but there was no rebound tenderness or guarding and bowel sounds were normal.Her initial blood tests were normal: haemoglobin 135 g/l, white cell count 4.7 x 10 9 /l, platelets 362 g/l, and C-reactive protein < 5.0. However her INR was 3.5.Her ECG revealed a paced rhythm of 95 beats/min. Her chest radiograph revealed one pacemaker sited in the left pectoral region and on the abdominal radiograph an epicardial pacemaker device in the right lower abdomen.The initial impression was that of appendicitis. Her warfarin was stopped and she was commenced on i.v. heparin. She was started on ciprofloxacin. An abdominal and pelvic computerised tomography (CT) scan was performed which revealed an intraperitoneal pacing device in the right iliac fossa which produced substantial artefact. The appendix looked prominent but there was no associated fluid collection or mass lesion (Fig. 1).She continued to have right iliac fossa pain and so a diagnostic laparoscopy was performed 3 days after admission. The findings were that of the epicardial pacemaker lying in the right iliac fossa adjacent to the caecum with its wires intimately related to the caecum. The gross appearance of the appendix and pelvic organs was normal. The decision was made to terminate the operation and the patient was transferred to Harefield Hospital where she underwent a laparotomy. At surgery, the pacemaker was Pacemaker migration is a rare, but important, complication of pacemaker insertion mainly documented in children. We report the case of a 60-year-old woman who was admitted with right iliac fossa pain thought to be caused by appendicitis. She was noted to have both an epicardial and endocardial pacemaker in situ. Imaging and laparoscopy revealed migration of the epicardial pacemaker to the right iliac fossa. We describe the possible mechanisms of pacemaker migration.

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Section: Discussionmentioning

confidence: 92%