[Antral impaction and cardiorespiratory arrest. Complications of the intragastric balloon]

Acute pancreatitis secondary to migration and impaction of an intragastric balloon

Obesity represents a significant global health problem, and reducing its alarmingly high incidence is an urgent challenge. The intragastric balloon is a safe and effective device for weight loss; therefore, it is widely used. Although the frequency of serious complications resulting from its use is low, it is not exempt from them. We would like to present a case of a severe but infrequent complication secondary to this device, with the aim of highlighting the most appropriate procedure in such cases and emphasizing the importance of awareness regarding it.

Intragastric balloon

The intragastric balloon is a temporary and minimally invasive therapy for weight loss, currently being the main choice for mild obesity. As a space-occupying device, it reduces stomach capacity, resulting in decreased hunger and food intake. There are different balloon models, filled with liquid or air. The most used is the non-adjustable liquid-filled balloon, due to its lower rate of complications. The mechanism of action is multifactorial, involving physiological and neurohormonal changes. The device functions as an artificial bezoar, filling the stomach and leading to early satiety. In the Brazilian Intragastric Balloon Consensus Statement, there was a mean excess weight loss of 18.4%, showing effective weight loss and good safety profile. It is a valid option for overweight and obese patients unresponsive to clinical therapy or who are either not candidates for surgery or who do not wish to undergo a definitive procedure. Besides weight loss, recent studies have shown a positive effect on metabolic parameters. New devices have been developed, such as procedureless and adjustable balloons, with promising results.

Bowel Obstruction due to Migration of an Intragastric Balloon Necessitating Surgical Removal before Completion of the Recommended 6 Months

We report a 25-year-old man with small bowel obstruction due to migration of a saline-filled intragastric balloon before the completion of the recommended 6 months of treatment who presented to the emergency department with abdominal pain. The patient had received a gastric balloon insertion 5 months prior. Within 24 hours of the original procedure, he noticed urine staining. The results of an endoscopy conducted the next day were normal. After ruling out other possible complications using endoscopy and confirming the diagnosis by computed tomography (CT) scan and conservative treatment for 48 hours the patient underwent surgery and the balloon was extracted. Due to the growing prevalence of obesity and the modalities used for treating it, physicians should be familiar with the side effects of each option and their presenting symptoms as well as the differential diagnosis they should not miss. Physicians must also improve their knowledge of how to approach these patients to avoid life-threatening complications caused by these modalities.