What is it about?
A post-splenectomy patient suffers from frequent infections due to capsulated bacteria like Streptococcus pneumoniae, Hemophilus influenzae, and Neisseria meningitidis despite vaccination because of a lack of memory B lymphocytes. Pacemaker implantation after splenectomy is less common. Our patient underwent splenectomy for splenic rupture after a road traffic accident. He developed a complete heart block after seven years, during which a dual-chamber pacemaker was implanted. However, he was operated on seven times to treat the complication related to that pacemaker over a period of one year because of various reasons, which have been shared in this case report. The clinical translation of this interesting observation is that, though the pacemaker implantation procedure is a well-established procedure, the procedural outcome is influenced by patient factors like the absence of a spleen, procedural factors like septic measures, and device factors like the reuse of an already-used pacemaker or leads.
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Why is it important?
A post-splenectomy patient suffers from frequent infections due to capsulated bacteria like Streptococcus pneumoniae, Hemophilus influenzae, and Neisseria meningitidis despite vaccination because of a lack of memory B lymphocytes. Pacemaker implantation after splenectomy is less common. Our patient underwent splenectomy for splenic rupture after a road traffic accident. He developed a complete heart block after seven years, during which a dual-chamber pacemaker was implanted. However, he was operated on seven times to treat the complication related to that pacemaker over a period of one year because of various reasons, which have been shared in this case report. The clinical translation of this interesting observation is that, though the pacemaker implantation procedure is a well-established procedure, the procedural outcome is influenced by patient factors like the absence of a spleen, procedural factors like septic measures, and device factors like the reuse of an already-used pacemaker or leads.
Perspectives
Multiple factors that can lead to recurrent pacemaker pocket infections are patient-related, device-related, or procedure-related. A recurring pacemaker pocket infection in a post-splenectomy patient has not been reported earlier in this report. The other risk factors for recurrent pacemaker pocket infection in our case are things like abandoned leads on the left side, the reuse of a sterile pacemaker, and referrals for pocket infection to other centres. The latter risk factors usually do not pose great challenges, as in our case, where the patient needed seven surgeries over a period of one year, which makes this pacemaker pocket infection so interesting. The absence of bacterial growth in our case can be explained by the previous pneumococcal vaccination and partial treatment with several regimens of empirical antibiotics.
Dr Ramachandra Barik
All India Institute of Medical Sciences
Read the Original
This page is a summary of: Pacemaker Pocket Infection After Splenectomy, Cureus, March 2023, Springer Science + Business Media,
DOI: 10.7759/cureus.35920.
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