乳児期に骨盤内へ脱落した新生児期ペースメーカ植込み術

Pacemaker Dislocation into the Peritoneal Cavity

小児期，特に新生児期における心外膜リード植込みは，リード選択，ジェネレータ選択，植込み部位など症例に応じた治療を要する．新生児では皮下組織，筋層が菲薄であり，皮膚潰瘍や腹腔内への脱落などによる合併症も報告されている3～7）．われわれは，腹直筋下に植込みを行った後腹腔内へ脱落し，回収と再固定を要した1例を経験したので報告する．

A 16-day-old neonate with congenital complete atrioventricular block underwent epicardial pacemaker implantation under the rectus. Four months later, abodominal X-ray imaging revealed dislocation of the generator from the abdomen to the pelvis. The infant was diagnosed with intraperitoneal pacemaker dislocation. However, there were no abdominal manifestations or complications associated with the bowel, urinary tract, and vascular system. Surgical refixation was performed in a hybrid room. Fluoroscopy helped avoid bowel injury when removing the generator from the peritoneal cavity. The pacing lead, which was adherent and entangled with the omentum, was released under direct vision. The generator was placed in a new pocket created in the subcutaneous layer of the anterior fascia of the rectus.