Pacemaker migration into the peritoneal cavity in children: a case series

Cardiac pacemakers can have a variety of complications, one of which is migration into the peritoneal cavity. This complication, which can have variable clinical manifestations, has rarely been reported in pediatric patients. Patient 1 was an 8-year-old female who had a pacemaker placed at the age of 1 year due to periodic asystole. She presented with rectal extrusion of a pacemaker lead. Computerized tomography (CT) scan confirmed the migration of the pacemaker generator and the lead to the area of the rectum. The devices were successfully removed transrectally. Patient 2 was a 19-year-old male with complete AV block who had a dual chamber pacemaker placed at the age of 7 years. Migration was detected at the age of 17 years on a routine abdomen/chest x-ray, and was confirmed on a CT. Laparoscopic retrieval was done at the age of 19 years. Patient 3 was a 1-year-old male with congenital heart disease requiring pacemaker placement at the age of 3 months. During a transvenous lead replacement at the age of 15 months, intraperitoneal migration was incidentally noticed at the time of the abdominal wall incision. The device was removed and replaced through the same incision. Patient 4 was a former 27 weeker male who had a pacemaker placed at the age of 5 months. At the age of 7 months, an abdominal x-ray done for unrelated reasons suggested possible pacemaker migration. Given that the patient was asymptomatic, and that the pacemaker was functioning properly, the pacemaker was left in place at that time and removed much later when the patient was 3 years old. Migration of abdominal wall pacemakers in pediatric patients may present with or without symptoms. In select asymptomatic cases with preserved device function, delayed or elective surgical intervention may be considered.