What could happen if you insert a BioEnterics intragastric balloon after sleeve gastrectomy?

Abstract

A 49-year-old previously healthy female patient with a body mass index (BMI) of 41 kg/m had undergone an SG 3 years before presentation to our hospital. She had lost 30 kg but then regained 10 kg because of increased food intake, and she had failed to maintain all conservative measures. Her treating physician has decided to insert an intragastric balloon with a capacity of 300 mL until tension on the gastric wall could be observed. She was referred to us 2 hours later as she experienced abdominal pain, retching, and hematemesis. Her vital signs and abdominal examination were normal. Therefore, the balloon was removed; however, a gastric mucosal tear was observed, but it went unrecognized as a full-thickness tear at this time. The patient was admitted for observation. Two hours later, she developed tachycardia, (heart rate [HR] 1⁄4 110 beats/ min), hematemesis, and abdominal distention. A standing abdominal film revealed a huge amount of air under the diaphragm (Fig. 1). Thus, a decision was made to perform