Automatic implantable cardioverter defibrillator (AICD) within the abdomen as a cause of adhesive small bowel obstruction (ASBO): a case report

Adhesive small bowel obstruction (ASBO) is commonly caused by intra-abdominal adhesions, usually from prior surgery. Conservative management is the mainstay of treatment, with adhesiolysis required for non-resolving obstruction. An unusual patient presentation of ASBO is presented here, where the cause is proposed as an automatic implantable cardioverter defibrillator (AICD) within the abdomen. Although the patient had several presentations of ASBO successfully treated with conservative management, a non-resolving obstruction required surgical management. At laparotomy, the AICD was found to be in close association with extensive matted adhesions to adjacent small bowel. Adhesiolysis was performed, with the AICD implanted in a subrectus pocket. The patient had an uncomplicated recovery, and at review 6 weeks following the operation was found to have a normal bowel habit with nil further episodes concerning for obstruction. This case highlights the importance of non-classical risk factors being a possible cause of ASBO.