Small Bowel Obstruction Secondary to Coiling of Gastric Electrical Stimulator Leads: A Rare Complication of Gastroparesis Management

Area of Science:

• Gastroenterology
• Surgical Technology
• Medical Imaging

Background:

• Gastroparesis, characterized by delayed gastric emptying without obstruction, often necessitates surgical intervention like gastric electrical stimulation (GES) when conservative methods fail.
• GES is an established treatment for refractory gastroparesis, involving implanted leads to regulate gastric motility.

Observation:

• A 53-year-old woman with idiopathic gastroparesis, 13 years post-GES implantation, presented with acute nausea, vomiting, and abdominal pain.
• Computed tomography (CT) imaging demonstrated a high-grade small bowel obstruction attributed to the coiling and migration of the existing GES leads.

Findings:

• Intraoperative findings confirmed the GES lead migration as the cause of the mechanical small bowel obstruction.
• The patient underwent enterolysis, lead explantation, and successful implantation of a new GES system.

Implications:

• This case underscores a rare but significant complication of GES: lead migration leading to bowel obstruction.
• Radiologists and surgeons must meticulously evaluate lead positioning in symptomatic patients with implanted devices to ensure timely diagnosis and prevent severe outcomes like bowel ischemia.