Complete small-bowel obstruction from a migrated intra-gastric balloon: emergency laparoscopy for retrieval via enterotomy and intra-corporeal repair.

A 49-year-old female (weight 81 kg, height 161 cm, BMI 31.2) presented at the emergency department complaining of 2-day history of worsening cramp-like abdominal pain and vomiting. She had not passed stools or flatus in the last 36 h and reported to have had an intra-gastric balloon (BioEnterics Intra-gastric Balloon, Allergan. Inc, Irvine, Calif) inserted 9 months earlier to treat grade I obesity. The balloon was introduced during an upper endoscopy at another institution in Latin America, and she denied having any follow-up since moving to Europe. While in the E.R., an abdominal x-ray and abdominal triple contrast CT scan (with oral water-soluble contrast) showed a complete small-bowel obstruction caused by the distal migration of a foreign body. This was consistent with the intra-gastric balloon impacted in the distal jejunum. Free fluid was also evident. Emergency surgery was mandatory, and a laparoscopic approach was chosen. After identification of the cecum and ileocecal valve, the small intestine was carefully inspected starting from the distal ileum by "run-the-bowel", proximally. An evident transition point between collapsed and distended bowel loops was identified, and a clear bulging of the bowel wall caused by the deflated and impacted balloon was observed at the site. A transverse enterotomy 3.5 cm in length was performed with laparoscopic scissors, distally to the obstruction site. The balloon was gently pulled out, taking care not to tear or damage the bowel and once removed was placed within an endobag. Laparoscopic enterorrhaphy was performed with double-layer intra-corporeal suture. The postoperative course was uneventful.