Tuesday, June 2, 2015

Dangerous complications caused by intragastric balloon

Severe, morbid obesity is a life-threatening condition which is becoming more and more prevalent all over the world. When diet and exercise are not enough, bariatric surgery can successfully bring patients' weight under control. There are several types of bariatric operations. Some, e.g. the sleeve gastrectomy procedure, consist in shrinking the stomach to restrict food consumption; others, such as the popular gastric bypass, involve removing or rearranging a portion of the digestive tract to impair the absorption of calories and nutrients.

In the case of younger and less obese patients, reversible procedures such as gastric banding or intragastric balloon are often used. Gastric banding involves placing a band around the stomach, which is then progressively tightened to restrict food intake. An intragastric balloon means that a deflated balloon is placed in the stomach and then filled with saline to decrease the amount of gastric space. The balloon can be left in the stomach for a maximum of 6 months. This method may be used prior to another bariatric procedure to help the patient reach a safer weight before radical surgery. It is fully reversible and is considered relatively safe. However, in rare cases even this simple procedure can lead to unexpected complications. In one notable case, a metallic ring broke off from the balloon, migrated to the small bowel and caused a potentially life-threatening intestinal perforation.

A 45-year-old man of Middle Eastern origin, morbidly obese, with a body mass index of 39, had an intragastric balloon inserted. The balloon was filled with 500 mL of saline/methylene blue. Initially everything was just fine, but after 8 weeks the patient reported to the emergency department, complaining of abdominal cramps, a lack of appetite and nausea. An ultrasound of the abdomen was performed and confirmed the balloon to be in place without any abnormality. The patient was discharged home on symptomatic medication. Since the pain didn't subside, 2 days later he returned to the ER. This time, a mild generalized abdominal tenderness was noticed on clinical examination, so a computed tomography scan was performed for further evaluation. It revealed that, although the intragastric balloon remained in its proper position, its metallic safety ring had broken off and migrated to the small bowel. There were no clinical or radiological signs of intestinal obstruction. 

The patient was hospitalized for observation, advised to eat and drink nothing, and was started on IV fluids. He became completely asymptomatic. The next morning, he underwent an upper gastrointestinal endoscopy and the balloon was retrieved.

The following night, the patient suddenly experienced severe abdominal pain, so an X-ray of the abdomen was performed and showed free air under the right dome of the diaphragm. An emergency laparotomy was performed and two small perforations were found at the site where the metallic ring was entrapped. The ring was removed and the perforations were repaired. 

Free air under the diaphragm.

Endoscopic and gross eye views of both balloon and its broken ring after extraction.  
All images from: Zubaidi et al. (2015)

The metallic safety ring prevents distal migration of the device if the balloon ruptures. However, 
in this case, the ring became detached from the rest of the system and migrated down to the jejunum while the balloon remained in the stomach. The resulting jejunal perforation required immediate surgical repair.

The patient can probably consider himself fairly lucky, since prompt medical attention and emergency surgery helped him avoid much more severe complications (e.g. peritonitis) or even death.

Zubaidi AM, Alghamdi HU, Alzobydi AH, Dhiloon IA, Qureshi LA. (2015) Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life-threatening situation. World J Gastrointest Endosc. 7(4): 429–432.

1 comment:

  1. Try to maintain a real diet make your body light weight to follow:-The stomach balloon is something that has risen to all new height and there are many found taking up this process to control body weight. The best thing about the stomach balloon weight loss is that it is recommended by many around the world and it has started grabbing the attention of many individuals looking to control body weight.