We present the case of a 53-year-old woman who underwent intragastric balloon (IGB) placement for obesity (body mass index [BMI], 30.2 kg/m2) after medical therapy had failed. The IGB was filled with 700 mL saline solution. On postoperative day 42, she experienced severe abdominal pain, without nausea or fever. The patient had bulging of the abdominal wall and presented with diffuse pain and tenderness (A).
An abdominal radiograph showed hyperinflation if the IGB (B). Laboratory tests showed elevated C-reactive protein (32 mg/L), amylase (550 U/L), and lipase (1890 U/L), and normal white blood count. CT showed distension of the IGB (1200 mL), with an air-fluid level, compressing the body of the pancreas with upstream pancreatic duct dilatation. Additionally, a tear in the rectus abdominis was seen (C) (Video 1, available online at www.giejournal.org).
EGD confirmed hyperinflation, and IGB removal was performed (D). The patient had improvement of her symptoms and was discharged on the second day after removal of the IGB. During follow-up, US of the abdomen showed no stones or sludge in the gallbladder and no dilatation of the pancreatic duct. Additionally, laboratory test results had normalized.
In summary, hyperinflation of an IGB can occur, and early diagnosis with IGB removal is essential to avoid severe adverse events.
Disclosure
Dr Thompson is a consultant for Boston Scientific, Olympus, Apollo Endosurgery, Fractyl, and USGI Medical. The other authors disclosed no financial relationships.
Commentary IGB therapy has come and gone and has now come back again. Many surgeons and gastroenterologists in the United States are now once again placing IGBs as a means of nonsurgically promoting weight loss in their patients. This case illustrates multiple adverse events (eg, rectus abdominus tear, muscle pancreatitis, abdominal distension) resulting from overinflation of an IGB.
This patient was treated by removal of the offending overinflated IGB, which seems reasonable. Another option, if the device would allow it, is partial deflation to reduce the mechanical pressure on nearby organs, although that was not done in this patient. Despite the benefits of these devices, they do have drawbacks, and every center that places them has seen some therapeutic misadventures. The ideal endoscopic treatment for obesity has yet to be developed, but balloons represent an intermediate step that allows patients to achieve some meaningful success.
Douglas G. Adler, MD, FASGE, GIE Senior Associate Editor, University of Utah School of Medicine, Salt Lake City, Utah
Mohamed O. Othman, MD, Associate Editor for Focal Points
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Published online: December 19, 2019
Mohamed O. Othman, MD, Associate Editor for Focal PointsIdentification
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© 2020 by the American Society for Gastrointestinal Endoscopy
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