Presentation
Constipation, nausea and vomiting for 7 days, and colicky epigastric pain for 3 days. On examination, tender epigastrium. Raised white cell count.
Patient Data
A radiodense opacity is noted overlying the lower abdomen, just to the right of the midline. A dilated loop of small bowel is seen in the left upper quadrant.
Following the abdominal x-ray, the patient disclosed that a year prior to admission she had traveled abroad for private weight loss surgery and had had an air-filled gastric balloon inserted. The patient was advised that the air-filled balloon needed to be removed after 6-12 months but this follow up procedure had not occurred.
The foreign body seen on the abdominal x-ray was thought to be the migrated, deflated gastric balloon, and a CT was requested for further evaluation.
There is a tubular foreign body with serpiginous linear margins within the small bowel, with proximal small bowel dilatation and no evidence of bowel perforation. A valve-like structure is seen on the medial aspect of the foreign body. This confirmed the clinical diagnosis of a deflated gastric balloon which had migrated and become impacted in the small bowel. The stomach is empty and there is no extraluminal foreign body.
Case Discussion
The gastric balloon had spontaneously deflated and migrated into the small bowel, causing small bowel obstruction.
Following the CT, an exploratory laparotomy was performed and the gastric balloon was removed from 50 cm proximal to the terminal ileum. The patient was discharged after 4 days with simple analgesia without follow-up and there were no further complications.
Gastric balloons may be inserted as a means to induce weight loss. Adverse outcomes of air-filled gastric balloons include difficulty with removal, gastric ulcers and spontaneous deflation. Spontaneous deflation can lead to serious complications including migration from the stomach necessitating surgical removal.
Case published with assistance from Dr Vikas Shah.
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