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Erschienen in:
26.02.2016 | GI Image
Small-Bowel Obstruction Secondary to Migration of an Intragastric Balloon
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 7/2016
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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.
Fig. 1
a Upper gastrointestinal series showing a dense device of 20 × 5 cm located in the right iliac fossa with upstream distended small-bowel loops suggestive of small-bowel obstruction. b, c Computed tomography showing dilated small-bowel loops (2) without signs of severity, upstream of a foreign body corresponding to the deflated and migrated IGB (1), with flat bowel loops downstream (transition area)
Fig. 2
a Intraoperative findings showing the IGB impacted within the ileum (arrow) with upstream small-bowel dilatation without signs of severity. b Antimesenteric enterostomy and IGB extraction
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