Extensive Gastric Necrosis and Perforation Secondary to Intragastric Balloon-Related Gastric Outlet Obstruction: A Case Report

Intragastric balloons (IGBs) are widely used as temporary endoscopic therapy for obesity, but rare complications can be catastrophic.A 55-year-old woman presented with severe epigastric pain, persistent vomiting, and progressive abdominal distension four months after the placement of a 650-mL Orbera intragastric balloon (Apollo Endosurgery, Austin, TX).She was hypotensive and tachycardic and presented with generalized peritonitis.Contrast-enhanced CT revealed marked gastric distension, antropyloric balloon impaction, absent mural enhancement along the lesser curvature, pneumoperitoneum, and free intraperitoneal fluid.Emergency laparotomy uncovered extensive gastric necrosis with a 4-cm perforation.The intact balloon was removed, and total gastrectomy without immediate esophagojejunal reconstruction was performed along with feeding jejunostomy.Histopathological examination confirmed complete transmural infarction and necrosis of the lesser curvature, severe diffuse acute ischemic injury of the adjacent gastric wall with vascular microthrombi, and localized fibrinous peritonitis, with no malignant neoplasm.Despite intensive care, refractory septic shock and multiorgan failure continued to progress, and the patient died 72 hours postoperatively.This case highlights the need for urgent imaging and source control when persistent pain, vomiting, or distension develops in a patient with an IGB.