Small bowel obstruction and the Garren-Edwards gastric bubble: an iatrogenic bezoar

Subsequent to its introduction as an adjunct to diet and behavioral modification in the management of exogenous obesity, the major complication of the Garren-Edwards gastric bubble (GEB) was small bowel obstruction (SBO) due to balloon deflation and obstruction in the jejunum or ileum. Seventy-two cases of patients with SBO due to the GEB requiring surgery and 15 cases of patients with SBO treated medically were reviewed in an attempt to determine risk factors predicting obstruction and to evaluate for treatment methods that might avoid the need for surgery. In these patients a deflated GEB behaved as a typical blunt foreign body. If the device is found to be in the small bowel and fails to pass or move and is associated with fever, leukocytosis, or complete SBO, surgery is required since the bowel may become ischemic, predicting the same high risk outcome seen with other blunt foreign bodies. With the introduction of other similar devices in the near future, since these devices behave as blunt foreign bodies, it cannot be assumed that they will pass uneventfully and appropriate evaluation and therapy must be initiated.