Rectal Perforation due to Interstim® Sacral Neuromodulation Device Lead Migration

Sacral neuromodulation (SNM) implantable devices such as the InterStim® device by Medtronic carry a small risk of stimulatory lead migration. In very rare cases migrated leads can injure the rectal wall resulting in a full-thickness perforation. The sequela of rectal perforation by SNM leads may have varied clinical presentation, and can remain undiagnosed without appropriate suspicion, increasing the risk for further complications.

A 43-year-old woman with a history of multiple SNM device revisions presented to our emergency department (ED) with rectal pain and gastrointestinal symptoms. SNM lead migration into the rectum and a full thickness perforation was visualized on computerized tomography (CT) imaging. A multidisciplinary evaluation was performed, and a subsequent management plan was developed for this patient's rare complication. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Rectal perforation is a rare event, and it is even more rare as a result of SNM lead migration. As emergency physicians, we should be aware of this rare complication, as the use of implantable SNM devices has risen over the last few decades. Based on the very few prior case reports, prognosis appears to be excellent, but prompt recognition of the complication is important to streamline proper management and prevent more serious downstream complications of untreated rectal perforation.