The use of laparoscopy in a rare case of of gastric perforation by an intragastric balloon

Abstract text (incl. references and figure legends)

Case history

We reported a case of a 42-year-old obese woman IMC 42, who presented signs and symptoms of acute abdomen and a 3 month history of endoscopic placement of intragastric balloon (IGB). The patient get the intragastric balloon as a bridge therapy in order to face a bariatric procedure.

Clinical findings

The patient was referred to our Emergency Department with an acute onset of severe epigastric pain and a sensation of mass in the stomach. The pain started 24h before in the epigastrium and gradually progressed to the whole abdomen and was associated with nausea but no vomiting.

Results

Abdominal X-Ray did not reveal any free air under diaphragm, but it shows the big IGB (Image 1). TC Scan of Abdomen and Pelvis revealed moderate degree of free fluid in the abdomen and some tiny pockets of sub capsular air nearby the stomach and an impression of perforated stomach (Image 2).

Diagnosis

Gastric perforation with peritonitis caused by an IGB

Therapy and progressions

Patient was admitted and started on broad spectrum antibiotics, intravenous fluids. Patient accessed the operating room and a laparoscopy was performed by a consultant with 12 years of specialized training. The laparoscopy confirmed the gastric perforation caused by the IGB. We performed a gastrotomy to deflate the IGB filled with Methylene blue and extract it; the gastrotomy was closed with barbed suture. She recovered well from surgery and within days she was tolerating a diet. Broad spectrum antibiotics were given for 10 days.

Comments

Although, gastric perforation usually occurs in the first six months, it is a rare complication reported in 0.1%. An upper gastrointestinal endoscopy could be arranged to deflate the IGB but the use of laparoscopy in an emergency intervention is increasingly widespread and we cannot forget its benefits for the patient.

References

DOI:10.1007/s11695-010-0314-9 DOI:10.1007/s11695-012-0607-2 DOI:10.3748/wjg.15.5751 DOI:10.1016/j.ijscr.2020.09.005

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