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Case Reports
. 2015 Apr 16;7(4):429-32.
doi: 10.4253/wjge.v7.i4.429.

Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation

Ali M Al-Zubaidi  1 , Hassan U Alghamdi  1 , Abdu H Alzobydi  1 , Irshad A Dhiloon  1 , Laeeque A Qureshi  1
Affiliations
Case Reports

Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation

Ali M Al-Zubaidi et al. World J Gastrointest Endosc. .

Abstract

A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

Keywords: Intragastric balloon; Morbid obesity; Perforation; Safety ring; Spatz adjustable balloon.

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Figures

Figure 1
Figure 1
Abdominal computed tomography scan showing the safety ring migrated to the small bowel (A and B) (white arrows) and (C) the balloon was in the stomach (black arrow).
Figure 2
Figure 2
Free air under the diaphragm.
Figure 3
Figure 3
Endoscopic and gross eye views of both balloon and its broken ring after extraction.
See this image and copyright information in PMC

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