Gastric necrosis following intragastric balloon placement: urgent sleeve gastrectomy as a rescue and definitive procedure

Use of an intragastric balloon (IGB) as a temporary weight-loss procedure in obese patients has become widespread since 1982 [1] [2]. We present a case of gastric necrosis following balloon refilling, successfully treated with an urgent vertical sleeve gastrectomy.

A 55-year-old woman with a body mass index (BMI) of 33.6 kg/m² had undergone IGB placement (Spatz Adjustable Balloon System; Spatz FGIA Inc., Jericho, New York, USA). After 3 months, the IGB was refilled. The patient came to the emergency unit with vomiting and abdominal pain 34 hours after the IGB was refilled.

On admission, the woman presented with hypotension and tachycardia. A nasogastric tube was inserted, yielding 3 L of gastric content. After the patient was stabilized, an urgent computed tomography (CT) scan revealed gastric dilatation with wall pneumatosis and signs of perforation ([Fig. 1]).

Fig. 1 a Axial computed tomography (CT) image after intravenous contrast agent administration, showing gastric dilatation and wall thickening. b Coronal CT image showing gastric wall thickening with thin linear air bubbles, suggesting gastric necrosis and perforation.

An urgent laparotomy was carried out. On exploration, gastric necrosis and perforation were confirmed ([Fig. 2]). A vertical sleeve gastrectomy was performed. An intraoperative endoscopy assessed the viability of the remnant esophagogastric junction and gastric mucosae. The patient was discharged from hospital on the postoperative day 15. The patient was in good condition 6 months after the sleeve gastrectomy, with a BMI of 29.1 kg/m².

Fig. 2 Intraoperative finding: gastric dilatation with necrosis of the fundus and greater curvature.

Since the first IGB placement by Nieben and Harboe in 1982, there has been a steep increase in the number of these procedures as a temporary measure for losing weight [1] [2]. Among the major IGB complications reported, several stand out: balloon deflation and migration, intestinal obstruction, and massive gastric dilatation with necrosis and perforation [3] [4].

Regarding gastric necrosis in patients with IGB devices, a total of 16 cases have been previously reported. In our case, the perforation was diagnosed 48 hours after refilling the balloon device. There has been only one previous case in which an emergency sleeve gastrectomy was performed as a rescue treatment for gastric fundus necrosis in a patient with gastric banding and a misdiagnosed type II paraesophageal hernia [5].

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Competing interests: None

• References

• 1 Nieben OG, Harboe H. Intragastric balloon as an artificial bezoar for treatment of obesity. Lancet 1982; 1: 198-199
• 2 Negrin Dastis S, Francois E, Deviere J et al. ssIntragastric balloon for weight loss: results in 100 individuals followed for at least 2,5 years. Endoscopy 2009; 41: 575-580
• 3 Giardello C, Cristiano S, Cerbone MR et al. Gastric perforation in an obese patient with an intragastric balloon, following previous fundoplication. Obes Surg 2003; 13: 658-660
• 4 Totté E, Hendrickx L, Pauwels M et al. Weight reduction by means of intragastric device: experience with the Bioenterics intragastric balloon. Obes Surg 2001; 11: 519-523
• 5 Bernante P, Breda C, Zangrandi F et al. Emergency sleeve gastrectomy as a rescue treatment for acute gastric necrosis due to type II paraesophageal hernia in an obese woman with gastric banding. Obes Surg 2008; 18: 737-741