Small bowel obstruction induced by spontaneous partial deflation of an intragastric balloon

Intragastric balloon

The intragastric balloon is a temporary and minimally invasive therapy for weight loss, currently being the main choice for mild obesity. As a space-occupying device, it reduces stomach capacity, resulting in decreased hunger and food intake. There are different balloon models, filled with liquid or air. The most used is the non-adjustable liquid-filled balloon, due to its lower rate of complications. The mechanism of action is multifactorial, involving physiological and neurohormonal changes. The device functions as an artificial bezoar, filling the stomach and leading to early satiety. In the Brazilian Intragastric Balloon Consensus Statement, there was a mean excess weight loss of 18.4%, showing effective weight loss and good safety profile. It is a valid option for overweight and obese patients unresponsive to clinical therapy or who are either not candidates for surgery or who do not wish to undergo a definitive procedure. Besides weight loss, recent studies have shown a positive effect on metabolic parameters. New devices have been developed, such as procedureless and adjustable balloons, with promising results.

Laparoscopic management of a migrated intragastric balloon causing mechanical small bowel obstruction: a case report and review of the literature

Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A 26-year-old woman had an intragastric balloon placed endoscopically for weight control 13 months previously. She presented to the emergency department with a four-day history of intermittent abdominal cramps and vomiting. Contrast enhanced computed tomography confirmed the presence of the intragastric balloon within the small bowel. At laparoscopic retrieval, the deflated intragastric balloon was found impacted in the terminal ileum approximately 15 cm from the ileocaecal valve. The balloon was retrieved by enterotomy and primary closure of the ileum without event. The risk of balloon deflation and subsequent migration increases over time but several published cases demonstrate that this complication can occur within six months of insertion. The initial approach to the treatment of migrated intragastric balloons causing small bowel obstruction should be determined by the location of impaction, severity of obstruction and the available skill set of the attending radiologist, endoscopist and/or surgeon. Balloons causing obstruction in the duodenum are likely amenable to endoscopic retrieval whereas impaction within the jejunum or ileum could be managed by percutaneous needle aspiration (in selected cases), endoscopy (double-balloon enteroscopy), laparoscopy or open surgery.

Small bowel obstruction from migrated intragastric balloon

Intestinal obstruction resulted from balloon migration is an extremely rare but serious late complication of the intragastric balloon (IGB). The aim of this study is to report a case of small bowel obstruction occurring in a middle age corpulent female following embedding of IGB. A 47-year-old obese female presented with abdominal pain, nausea, and vomiting for two days. She had a history of an endoscopically placed IGB nine months before presentation. Physical examination showed an obese woman with mild distress, and the right upper abdomen was tender. The plain abdominal radiograph showed gas shadow in the stomach and the duodenum, esophago-gastro-duodenoscopy showed an empty stomach and balloon migration from the stomach. Under general anesthesia, laparotomy was performed, a three-centimeter antimesenteric enterotomy was done and the balloon extracted from the proximal jejunum. Intestinal obstruction is an extremely rare complication of IGB. It should be managed by laparotomy and extraction of the balloon.

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Intestinal obstruction resulted from intragastric balloon migration is an extremely rare complication.

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It is serious complication and needs general anesthesia and laparotomy.

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In this study, a case of small bowel obstruction occurring in a middle age female following inserting of intragastric ballon has been presented and discussed.

Laparoscopic management of a small bowel obstruction secondary to Elipse intragastric balloon migration: A case report

INTRODUCTION

The Elipse™ intragastric balloon (IGB) for weight loss is a swallowable capsule that is filled with 550mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event.

PRESENTATION OF CASE

A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO), and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient's recovery was uneventful and she was discharged on postoperative day 4.

DISCUSSION

We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases.

CONCLUSION

Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully.

Complete small-bowel obstruction from a migrated intra-gastric balloon: emergency laparoscopy for retrieval via enterotomy and intra-corporeal repair

A 49-year-old female (weight 81 kg, height 161 cm, BMI 31.2) presented at the emergency department complaining of 2-day history of worsening cramp-like abdominal pain and vomiting. She had not passed stools or flatus in the last 36 h and reported to have had an intra-gastric balloon (BioEnterics Intra-gastric Balloon, Allergan. Inc, Irvine, Calif) inserted 9 months earlier to treat grade I obesity. The balloon was introduced during an upper endoscopy at another institution in Latin America, and she denied having any follow-up since moving to Europe. While in the E.R., an abdominal x-ray and abdominal triple contrast CT scan (with oral water-soluble contrast) showed a complete small-bowel obstruction caused by the distal migration of a foreign body. This was consistent with the intra-gastric balloon impacted in the distal jejunum. Free fluid was also evident. Emergency surgery was mandatory, and a laparoscopic approach was chosen. After identification of the cecum and ileocecal valve, the small intestine was carefully inspected starting from the distal ileum by "run-the-bowel", proximally. An evident transition point between collapsed and distended bowel loops was identified, and a clear bulging of the bowel wall caused by the deflated and impacted balloon was observed at the site. A transverse enterotomy 3.5 cm in length was performed with laparoscopic scissors, distally to the obstruction site. The balloon was gently pulled out, taking care not to tear or damage the bowel and once removed was placed within an endobag. Laparoscopic enterorrhaphy was performed with double-layer intra-corporeal suture. The postoperative course was uneventful.