Is Conservative Management for Gastric Perforation Secondary to Intragastric Balloon Possible? Case Report and Review of Literature

Abstract

Intragastric balloon (IGB) is one of the available options for the management of morbid obesity. The procedure is generally safe and of moderate efficacy in most of the cases. One of the reported complications of IGB is gastric perforation. The management of this complication is classically surgical. To our knowledge, conservative management for gastric perforation secondary to IGB has not been reported. A 27-year-old female patient presented with sudden abdominal pain in the left upper quadrant, 2 months after having an IGB placed. The provisional diagnosis was gastric perforation. Balloon extraction was performed and a conservative management of the gastric perforation was pursued successfully. We therefore propose that this sort of management might be adopted in carefully selected cases.

Late Intragastric Balloon Induced Gastric Perforation

“…The balloon might exert excessive pressure on the gastric wall, with subsequent erosion, ulcer, or eventual perforation [8]. Our case is the first report of late gastric perforation after adjustable IGB placement.…”

“…Late IGB-induced gastric perforation is a very rare complication, reported explicitly in only six previous cases of nonadjustable IGB [4][5][6][7][8]. The balloon might exert excessive pressure on the gastric wall, with subsequent erosion, ulcer, or eventual perforation [8].…”

“…Treatment options included endoscopic IGB retrieval alone [5,8], surgical IGB extraction through the tear via laparotomy [6,7] or laparoscopy [4] and suture repair, or combining endoscopic IGB retrieval with laparoscopy as attempted previously [4] and performed successfully by us. We had to temporarily deflate the endotracheal cuff in order to facilitate endoscopic IGB retrieval.…”

Gastric Perforation following Intragastric Balloon Insertion: Combined Endoscopic and Laparoscopic Approach for Management: Case Series and Review of Literature

“…However, after review of cases in the literature (Table 1), including the three cases in the present series, we found death of three out of 18 patients who presented with gastric perforation following IGB insertion (16.6 %). Such a high mortality rate raises doubts about the above recommendation by Bekhit M. et al [24].…”

“…Genco A. et al reported two cases in the Italian experience that were managed laparoscopically among five cases of gastric perforation [10], and later another case was reported showing the simultaneous procedure by an endoscopist and a surgeon in management [20]. On the other hand, Bekhit M. et al reported one case of successful conservative management of gastric perforation secondary to intragastric balloon insertion and concluded that such perforations can be treated conservatively in highly selected patients [24]. However, after review of cases in the literature (Table 1), including the three cases in the present series, we found death of three out of 18 patients who presented with gastric perforation following IGB insertion (16.6 %).…”