Intra-gastric balloon migration causing small bowel obstruction

Case contributed by Dr Henna Singh


Abdominal pain and distension. History of an intra-gastric balloon

Patient Data

Age: 50
Gender: Female

Abdominal radiograph demonstrates central dilated small bowel loops. There is a subtle radio-opacity projected overlying the right sacral region. IUCD in situ.

CT abdomen and pelvis with portal venous phase contrast demonstrates small bowel obstruction with transition point at the terminal ileum in which a large oblong shaped foreign body is impacted. This contains mixed metallic and possibly plastic components, which contains gas locules.

Although there is history of an intra-gastric balloon, this is not seen within the stomach. Therefore the findings are highly concerning for a spontaneously deflated and migrated intra-gastric balloon. There are also several short segments of narrowing and thickening of the small bowel proximal to this which are likely secondary to the passage of the balloon. 

Small volume of pelvic free fluid. No evidence of pneumoperitoneum. 

Patient went to theater and had a terminal ileum enterotomy performed in which a deflated, migrated intra-gastric balloon was confirmed and removed

Case Discussion

Migration of medical devices such as intra-gastric balloons are very rare but are life threatening when they happen and therefore, one should be aware of this and the radiological findings. 

Intra-gastric balloons are used as an alternative weight loss option if the patient does not wish to or cannot have surgery or have significant co-morbidities. They are a temporary option with the aim to increase satiety. 

The balloon is inserted endoscopically via the mouth, through esophagus and into the stomach. Then using an endoscope, the balloon is inflated. 

Risks associated are bleeding or perforation of the esophagus and stomach, reflux and discomfort after insertion and spontaneous deflation and migration of the balloon leading to small bowel obstruction. 

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