Helmuth T Billy1, Danial Cottam, MD2. 1Ventura Advanced Surgical Associates, Ventura California, 2Bariatric Medicine Institute, Salt Lake City Utah
Background: Saline filled intragastic balloons have become a common outpatient procedure for the treatment of obesity. Acute dilation,ischemia and necrosis of the stomach has been described in the medical literature. Gastric necrosis from acute gastric dilation is a rare but life-threatening condition, which requires timely diagnosis and management. We present a case of partial gastric ischemia with necrosis 72 hours following placement of a saline filled intragastric balloon. Postoperative complaints of bloating, nausea and vomiting are common complaints following placement of saline filled intragastric balloons and can lead to a delay in diagnosis. Early diagnosis and management is essential in avoiding this life threatening complication.
Case Report: A 59 year old woman, BMI 33, comorbid conditions of diabetes mellitus underwent uncomplicated placement of a saline filled intragastric balloon for treatment of obesity. 24 hours after placement the patient complained of cramping and bloating. 48 hours following placement the patient developed vomiting and presented to an emergency room for evaluation. She was found to have blood glucose exceeding 400 and a severely dilated stomach with pneumotosis on CT evaluation. NG tube decompression and ICU management of the severe hyperglycemia was initiated. Removal of the intragastric balloon was delayed 12-14 hours until an appropriate endoscopic retrieval kit could be obtained. Endoscopic retrieval was performed without incident and near complete necrosis of the gastric mucosa was noted. The antrum was the only area spared. 48 hours after retrieval a laparoscopic evaluation of the stomach revealed full thickness necross of the entire fundus and greater curve.
Indocyanine Green (ICG) Fluorescent Dye was used to assess vascular integrity of the remaining stomach and to define lines of resection. Resection of the greater curvature was performed using ICG florescent dye to ensure that the angle of Hiss was viable and well perfused. The patient had a full recovery and subtotal gastrectomy was avoided.
Conclusions: Spontaneous gastric distension exacerbated by gastric outlet obstruction following placement of a saline filled intragastric balloon can occur. Unrecognized this condition can lead to ischemia, necrosis and perforation of the stomach. Appropriate evaluation of patients following placement of intragastric balloons is essential. Recognition of this condition can be delayed due to the complaints of cramping, bloating and vomiting which are typical following placement of saline filled intragastric balloons. Untreated, gastric ischemia and necrosis can lead to early perforation which is associated with a high mortality rate
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88532
Program Number: P566
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster