Gastric Occlusion Due to Intragastric Balloon with Gastric Necrosis and Portal Pneumatosis

A 48-year-old female with a body mass index of 38 kg/m2 and previous insertion of an Orbera intragastric balloon (Bioenterics Intragastric Balloon, Apollo Endosurgery, Austin, TX) 7 days before presented with vomiting, tachycardia, and hypotension with tenderness in the upper abdomen. Blood analyses showed elevated C-reactive protein, renal failure, and electrolyte disorder. Abdominal computed tomography (CT) showed gastric occlusion due to the placement in the pylorus, with signs of gastric necrosis and extensive portal pneumatosis (Figure 1). No signs of perforation were seen. Fluid resuscitation was provided along with proton pump inhibitors (PPIs), antibiotics, and nil per os restriction. Gastroscopy showed gastric wall necrosis, so removal of the balloon was performed endoscopically. The patient was discharged 3 days later, with normal blood tests. A month later, abdominal CT showed no portal pneumatosis