Abstract
Background
Pacemaker implantation in children is nuanced. While indications for permanent pacing are similar to those in adults, the logistics of implanting large generators in small infants and children introduces many potential complications, perhaps most insidious migration. In small children, pacemaker leads are placed on the epicardium via sternotomy and the generator is placed anterior or posterior to the rectus abdominis sheath. This precarious position is prone to erosion.
Case Presentation
Our patient is an 8-year-old female with an underlying glycosylation disorder with multi-organ involvement and global developmental delay. She underwent permanent pacemaker placement at 2 years of age due to prolonged sinus pauses of unclear etiology. She presented to care several times for non-specific illness symptoms, with the pacemaker ultimately being found to have migrated into the gastrointestinal tract. The device was safely extracted via the rectum by general surgery.
Conclusions
We present a case of pacemaker migration into the gastrointestinal tract, review the literature on this infrequent but significant complication, and provide recommendations to aid in the prompt recognition of this predicament. This case highlights that routine assessment of a pacemaker’s position and function is critical to ensuring patient safety.