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Case Reports
. 2020 Jul 25;20(1):182.
doi: 10.1186/s12871-020-01101-y.

Direct acute respiratory distress syndrome after gastric perforation caused by an intragastric balloon: a case report

Nils Theuerkauf  1 , Tobias Weismüller  2 , Carsten Weißbrich  1 , Jens-Christian Schewe  1 , Christian Putensen  1 , Christian Bode  3
Affiliations
Case Reports

Direct acute respiratory distress syndrome after gastric perforation caused by an intragastric balloon: a case report

Nils Theuerkauf et al. BMC Anesthesiol. .

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition and the identification of the underlying direct (pulmonary) or indirect (non-pulmonary) cause is mandatory for a successful treatment. Intragastric balloon (IGB) therapy is a minimal invasive and supposedly harmless option to reduce body weight for the growing number of obese people. We present a case of a young patient who developed a direct ARDS due to initially undiagnosed abdominal pathologies caused by an IGB therapy.

Case presentation: A 23-year old woman was admitted because of a direct ARDS for extracorporeal membrane oxygenation (ECMO) therapy. Weeks before, an IGB has been removed because of abdominal pain and free intraabdominal air. Diagnostic work-up of free intraabdominal air, previous pain of the left shoulder and newly developed abscess pneumonia revealed a perforation of the posterior wall of the gastral antrum. This resulted in a left subphrenic abscess with destruction of the diaphragm, development of pneumonia per continuitatem and subsequent direct lung injury. The gastric perforation was endoscopically clipped and the ARDS was successfully treated under ECMO therapy.

Conclusion: This case illustrates that a patient presenting with direct ARDS may have upper abdominal pathologies caused by a rare complication of a supposedly harmless treatment.

Keywords: ARDS; Abscess; Chest imaging; Extracorporeal membrane oxygenation; Obesity treatment; Pneumonia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CT-scan of the upper abdomen with free abdominal air and indwelling intragastric balloon. IGB, intragastric balloon
Fig. 2
Fig. 2
Perforation of the posterior wall of the gastral antrum was endoscopically diagnosed
Fig. 3
Fig. 3
CT-scan demonstrating left subphrenic abscess with destruction of the diaphragm and development of pneumonia per continuitatem. LL, left lower lobe; SM, stomach; white asterisk: subphrenic abscess
See this image and copyright information in PMC

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