A FEARED COMPLICATION OF AN INTRAGASTRIC BALLOON HYPERINSUFFLATION

Introduction:

Bariatric endoscopy is rapidly emerging as an effective and less invasive alternative to bariatric surgery. IGB placement is one of the most common procedures performed for the treatment of obesity. The authors report a rare, but potentially serious, complication of IGB placement.

Case report:

A 46-year-old woman with an initial BMI of 31.6 kg/m2, with no other comorbidities. The patient was submitted to intragastric balloon (IGB) placement to treat mild obesity. Three months after the procedure, she had lost a total of 16 kg. At three months after the IGB placement, the patient consulted the bariatric endoscopy service due to epigastric pain over 48 hours, nausea, vomiting and abdominal distension. The patient reported progressive worsening of the pain, abdominal distension and vomiting. On physical examination, the patient had bulging of the upper abdominal and presented diffuse pain on palpation, but with no other signs of peritoneal irritation or hemodynamic instability. An abdominal X-ray was performed showing an increase in the diameter of the IGB. The patient was admitted to the emergency department and was treated with intravenous scopolamine, dipyrone and bromopride, which provided symptomatic relief. Due to the improvement of symptoms including the pain on palpation, the patient was fasted for 12 hours to try to reduce the gastric contents and diminish the risk of pulmonary aspiration, and an esophagogastroduodenoscopy with endotracheal intubation. After inspection of the gastric cavity and aspiration of a large quantity of gastric residues, IGB hyperinsufflation was confirmed and it was decided to empty the balloon. However, the IGB ruptured after puncturing it with the needle. The liquid contents of the IGB were aspirated and the balloon was later removed using endoscopic tweezers without further complications. The patient had clinical improvement and she was discharged on the same day as the procedure.