Gastric Obstruction Secondary to an Unexplained Hyperinflation of an Intragastric Balloon

Abstract

A 42-year-old-woman with medical history of cholecystectomy and obesity (1.63 m, 98 kg, body mass index 37 kg/m2) presented with suspicion of intestinal occlusion. Six months prior, an intragastric balloon (Orbera, Apollo Endosurgery, Austin, TX) had been placed to treat obesity, with a loss of 23 kg. For 2 months, the patient described progressive onset of abdominal pain, gastroesophageal reflux, and vomiting, with acute aggravation during the last 72 hours. Physical examination revealed a painful epigastric mass. Laboratory studies showed severe hypokalemia at 2.4 μmol/L. An abdominal computed tomography scan was performed, which showed the intragastric balloon with mixed content; liquid and gaseous; with a significant increase in volume to 1513 mL, contrasting to the 700 mL of water injected 6 months prior (Figures 1A and B). This hyperinflation seemed to be related to the unexplained appearance of the gas volume (about 800 mL) and caused gastric obstruction. Upper gastrointestinal endoscopy was performed, showing fluid stasis and allowing to empty and remove the balloon (Figures 1C–E). Some superficial ulcerations of the gastric mucosa were present. The patient was discharged 24 hours later. The prevalence of hyperinflation is estimated at 1% in large series. This complication may be caused by contamination of balloon by pathogens (fungal or bacterial). Appearance or recrudescence of symptoms, several months after balloon placement, should induce an abdominal x-ray to eliminate hyperinflation.