Gastric balloon causing small bowel obstruction: treatment by double-balloon enteroscopy

A 32-year-old woman was referred to our emergency department because of abdominal pain and vomiting. She had received a gastric balloon in an outpatient clinic 5 years previously to treat obesity, but had not attended follow-up appointments. Emergency computed tomography showed a partially deflated gastric balloon ([Fig. 1], arrow) in the mid part of the jejunum with proximal dilatation of the small bowel loops consistent with ileus.

Fig. 1 CT scan of the abdomen of a 32-year-old woman showing dilated small-bowel loops and the partially deflated gastric balloon (arrow).

To remove the gastric balloon from the jejunum, the patient was offered peroral double-balloon enteroscopy under conscious sedation. The gastric balloon was found at an insertion depth of 180 cm ([Fig. 2 a]). To empty the methylene-blue-containing saline out of the gastric balloon, a standard injection needle was used to perforate the silicone wall ([Fig. 2 b]). The deflated gastric balloon was folded up using a large polypectomy snare and was removed ([Fig. 2 c]). The symptoms resolved quickly and the patient was discharged the next day.

Fig. 2 a – c Removal of the gastric balloon by double-balloon enteroscopy: a gastric balloon in the mid part of the jejunum accompanied by superficial ulcerations; b perforation of the silicone wall with an injection needle; c removal of the gastric balloon with a polypectomy snare.

Insertion of gastric balloons is performed as a temporary measure for weight loss [1]. If a gastric balloon remains longer than scheduled, it may deflate spontaneously and cause obstruction by entering the bowel. Similar cases have been treated by surgery [2] [3] [4] [5]. However, double-balloon enteroscopy seems a promising method to treat bowel obstruction caused by partially deflated gastric balloons.

Endoscopy_UCTN_Code_CPL_1AH_2AK

• References

• 1 Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg 2008; 18: 1611-1617
• 2 Kim WY, Kirkpatrick UJ, Moody AP et al. Large bowel impaction by the BioEnterics intragastric balloon (BIB) necessitating surgical intervention. Ann R Coll Surg Engl 2000; 82: 202-204
• 3 Henninger C, Kramer M, Horger M et al. Ileus of uncommon cause – important and weighty facts. Dtsch Med Wochenschr 2009; 134: 2640
• 4 Hegade VS, Sood R, Douds AC. Small bowel obstruction induced by spontaneous partial deflation of an intragastric balloon. Ann R Coll Surg Engl 2012; 94: e171-e173
• 5 Moszkowicz D, Lefevre JH. Deflated intragastric balloon-induced small bowel obstruction. Clin Res Hepatol Gastroenterol 2012; 36: e17-e19