Presentation
Abdominal pain and vomitting for 5 days. History of intragastric balloon insertion for morbid obesity (BMI >40) one year ago.
Patient Data
A small T-shape opacity (red arrow in the magnified view) is seen projecting over the L5/S1 vertebra which is likely a marker of the spontaneously deflated and displaced gastric balloon. Multiple mildly dilated small bowel loops with small air fluid levels (partial small bowel obstruction?) are noted. No pneumoperitoneum is seen.
A well-defined tubular cystic structure with hyperechoic walls is seen in the right iliac fossa which is likely a deflated displaced gastric balloon. Mild amount of free fluid and a few mildly dilated small bowel loops are seen in the pelvis.
Findings:The spontaneously deflated and migrated intra-gastric balloon is visualized within the terminal ileum close to the ileocecal junction. Mildly dilated and thick walled proximal small bowel loops with delayed transit of the oral contrast are noted. Normal caliber colon. Small amount of free fluid is seen in the abdominopelvic cavity. No oral contrast extravasation is noted. No pneumoperitoneum is seen.
Conclusion: Spontaneously deflated intra-gastric balloon, migrated in to the terminal ileum associated with partial proximal small bowel obstruction.
Case Discussion
The patient was admitted and managed conservatively (NPO & IV fluids). 12 hours later, she passed the balloon with stools. She was discharged from the hospital in a stable condition.