Small-Bowel Obstruction Secondary to Migration of an Intragastric Balloon

Excerpt

A 41-year-old obese woman (body mass index (BMI) 31 kg/m²) presented herself to the emergency department with a 3-day history of gradually increasing colicky abdominal pain associated with nausea and vomiting. The pain was sharp, resistant to analgesics, and located in the right iliac fossa. She had undergone endoscopic insertion of an air-filled intragastric balloon (IGB) (Heliosphere®) 10 months ago and was lost to follow-up. On examination, the abdomen was bloated and tense, with no signs of peritoneal irritation. She had a white blood count of 12.4 × 10⁹/L and a C-reactive protein of 41.8 mg/L. Upper gastrointestinal series (Fig. 1a) and computed tomography findings (Fig. 1b, c) were suggestive of a deflation and migration of the IGB leading to small-bowel obstruction. Two hours later, she presented an intense abdominal pain with tachycardia and abdominal guarding. An emergency laparotomy was performed and confirmed the small-bowel obstruction with the IGB impacted within the ileum at 20 cm from the ileocecal valve (Fig. 2a). There were no signs of intestinal perforations or ischemia. A 3-cm antimesenteric enterostomy was performed distal to the IGB, allowing the safe removal of the device without intestinal resection (Fig. 2b). The postoperative course was uneventful and the patient was discharged 6 days after surgery.

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