title: Gastric perforation in an obese patient with an intragastric balloon, following previous fundoplication.
abstract: BACKGROUND
  The Bioenterics Intragastric Balloon (BIB) has been a safe and effective method used in treatment of moderate obesity. Gastric perforation is a rare complication, and its possible sequelae are dangerous.
  
  
  METHODS
  A 52-year-old women (BMI 37 kg/m(2)), with hiatal hernia, moderate hypertension and dyspnea, 1 year ago underwent laparoscopic fundoplication. She now underwent positioning of a BIB filled with 500 cc of saline. After 8 days, 6 kg weight loss occurred and her clinical condition was satisfactory. On day 11, severe abdominal pain and vomiting occurred, which spontaneously regressed in the following 6-8 hours. Ultrasound confirmed the correct position of the BIB, and showed widespread abdominal meteorism. On day 18, acute abdomen with paralytic ileus occurred. On admission, CT scan documented hydropneumoperitonitis. At operation, a large perforation of the lesser curvature was found, with undigested food in the abdomen. She underwent peritoneal lavage, removal of the BIB, and suture of the gastric laceration.
  
  
  RESULTS
  She was discharged in good condition after 11 days.
  
  
  CONCLUSIONS
  According to our experience, fundoplication represents an absolute contraindication to positioning of a BIB.
authors.affiliation: Department of Surgery, Hospital of Casoria S. Maria della Pietà, Naples, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giardiello
authors.forename: Stefano
authors.initials: S
authors.lastname: Cristiano
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Cerbone
authors.forename: Ersilia
authors.initials: E
authors.lastname: Troiano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iodice
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sarrantonio
mesh_terms: D000075202:Contraindications; D020878:Device Removal; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D015905:Gastric Balloon / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D013270:Stomach / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014463:Ultrasonography