PULSATING ABDOMEN: DIAGNOSTIC DILEMMA- A CASE REPORT

It is rare to find a patient with pulsating abdomen in the emergency room. We report a patient with pulsating abdomen having a rare diagnosis Twiddler's syndrome. Twiddler's syndrome is a permanent malfunction of the cardiac pacemaker due to the patient?s manipulation of the pulse generator. Due to this, the leads are dislodgedand can stimulate ipsilateral phrenic nerve leading to rhythmic diaphragmatic pacing and sensation of pulsating abdomen. This is a rare case report of an elderly male with Twiddler's syndrome resulting in pacemaker malfunction secondary to lead retraction. He subsequently underwent lead repositioning and appropriate counseling of not to manipulate the pacemaker pulse generator within its skin pocket.