Intragastric balloons (IGBs) are minimally invasive devices used for managing obesity. Despite their relative safety and patient tolerance, there have been reports of adverse events associated with IGBs. Gastric perforation is a rare but feared complication that mostly occurs as an early event after transitional interventions, such as insertion or removal procedures. This case report describes a combined endoscopic and laparoscopic approach to a rare case of late gastric perforation secondary to an IGB whose removal was long overdue.