A Case of Duodenal Obstruction and Pancreatitis Due to Intragastric Balloon

Abstract

Background: Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. Case Report: A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. Conclusion: Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon.

Keywords

• Duodenal obstruction, gastric balloon, pancreatitis

References

1. 1. National Institutes of Health [Internet]. Bethesda, USA. How Are Overweight and Obesity Treated? Available from: http:// www.nhlbi.nih.gov/health/health-topics/topics/obe/treatment. html
2. 2. Peker Y, Coskun H, Bozkurt S, Cin N, Atak T, Genc H. Comparison of results of laparoscopic gastric banding and consecutive intragastric balloon application at 18 months: a clinical prospective study. J Laparoendosc Adv Surg Tech A 2011;21:471-5. [CrossRef]
3. 3. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg 2008;18:841-6. [CrossRef]
4. 4. Ramadan MEA, Abdel Hamid HK, Ramadan AR, Abdel Kader AR. Bioenterics Intragastric Balloon: Safety, Tolerance, and Efficacy of 6 months Balloon Treatment: Egyptian Experience with 50 patients. N Y Sci J 2014;7:6-9.
5. 5. Genco A, Bruni T, Doldi SB, Forestieri P, Marino M, Busetto L, at al. Bioenterics intragastric balloon: The Italian experience with 2515 patients. Obes Surg 2005;15:1161-4. [CrossRef]
6. 6. Mathus-Vliegen EM. Intragastric balloon treatment for obesity: what does it really offer? Dig Dis 2008;26:40-4. [CrossRef]
7. 7. Angrisani L, Lorenzo M, Borelli V, Giuffre M, Fonderico C, Capece G. Is bariatric surgery necessary after intragastric balloon treatment? Obes Surg 2006;16:1135-7. [CrossRef]
8. 8. Sallet JA, Marchesini JB, Paiva DS, Komoto K, Pizani CE, Ribeiro ML, at al. Brazilian multicenter study of the intragastric balloon. Obes Surg 2004;14:991-8. [CrossRef]

9. 9. Holland S, Bach D, Duff J. Balloon therapy for obesity-when the balloon bursts. J Can Assoc Radiol 1985;36:347-49.
10. 10. Mohammed AE, Benmoua A. Acute pancreatitis complicating intragastric balloon insertion. Case Rep Gastroenterol 2008;2:291-5. [CrossRef]
11. 11. Ozturk A, Akinci, OF, Kurt M. Small intestinal obstruction due to self-deflated free intragastric balloon. Surg Obes Relat Dis 2010;6:569-71. [CrossRef]
12. 12. Gaggiotti G, Tack J, Garrido AB Jr, Palau M, Cappelluti G, Di Matteo F. Adjustable totally implantable intragastric prosthesis (ATIIP)- Endogast for treatment of morbid obesity: one-year follow-up of a multicenter prospective clinical survey. Obes Surg 2007;17:949-56. [CrossRef]
13. 13. Vanden Eynden F, Urbain P. Small intestine gastric balloon impaction treated by laparoscopic surgery. Obes Surg 2001;11:646-8. [CrossRef]