An 84-year-old man with an epicardial pacemaker implanted 15 years earlier due to complete atrioventricular block was admitted to the hospital for generator replacement. Over the years, X-rays had shown progressive migration of the epicardial pacemaker generator toward the left hypochondrium (Fig. 1A-B). Surgical intervention was programmed for generator replacement. A left subcostal incision revealed no device in the subcutaneous cell tissue, and so the abdominal cavity was accessed, identifying an intracolonic foreign body. Further studies were conducted to determine the definitive treatment. During colonoscopy, the generator was visualized in the colonic lumen (Fig. 2A), with the epicardial leads traversing the colonic wall (Fig. 2B). A definitive dual-chamber subclavian pacemaker was implanted, and we discussed the need for surgery to remove the generator with the patient, but he declined the procedure. Five months later, the patient arrived at the emergency service presenting with fever and general malaise. Computed tomography (CT) revealed a 5 × 5 × 3 cm epicardial collection (Fig. 3) and Streptococcus viridans, a microorganism belonging to the commensal flora of the digestive tract, was isolated in blood cultures. The patient’s condition progressively worsened, and despite antibiotic therapy, he died 10 days after hospital admission.

Figure 1.

A) Plain thoracic-abdominal X-ray showing the pacemaker generator in the epigastric region. B) Plain abdominal X-ray showing the pacemaker generator migrated into the left flank.

Figure 2.

A) Colonoscopic image visualizing the pacemaker generator in the lumen of the colon. B) Colonoscopic image showing the pacemaker leads ascending into the colonic wall.

Figure 3.

Axial view of the CT scan, showing the epicardial collection (white arrow), measuring 5 × 5 × 3 cm.