Gastric perforation in an obese patient with an intragastric balloon, following previous fundoplication.
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.
Giardiello
Cristiano
C
Department of Surgery, Hospital of Casoria S. Maria della Pietà, Naples, Italy.
Cristiano
Stefano
S
Cerbone
Maria Rosaria
MR
Troiano
Ersilia
E
Iodice
Giuseppe
G
Sarrantonio
Gennaro
G
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