Gastric Perforation Secondary to a Hyperinflated Intragastric Balloon: A Case Report and Management Approach

Intragastric balloon (IGB) placement is a widely used, minimally invasive intervention for obesity and metabolic disorders, offering a temporary, reversible alternative for weight management. It is generally well tolerated, with most complications being mild and self-limiting, such as nausea, vomiting, and abdominal discomfort. However, in rare cases, more serious complications can arise, including gastric ulceration, balloon migration, and, in extreme cases, gastric perforation. The latter can occur at any time from days to months after insertion, necessitating prompt recognition and surgical intervention to prevent life-threatening consequences. We report a case of a 47-year-old woman who presented with an acute abdomen four months after IGB insertion. Imaging revealed a hyperinflated IGB with associated gastric perforation. The patient was urgently taken to the operating room, where an on-table esophagogastroduodenoscopy confirmed the findings. Laparoscopic primary repair was performed following balloon removal. The mechanism behind IGB hyperinflation remains multifactorial. Computed tomography is the preferred imaging modality for diagnosis. In bariatric centers, a minimally invasive approach, combining endoscopic balloon removal with laparoscopic perforation repair, has demonstrated superior outcomes compared to open surgery, reducing morbidity and recovery time. Endoscopic balloon removal combined with laparoscopic repair offers significant advantages, including minimal scarring, faster recovery, and shorter hospital stays. Early detection and a multidisciplinary approach are crucial for optimal patient outcomes.