Presentation
Sudden onset abdominal pain and coffee ground vomit. 3 weeks post gastric balloon insertion for weight loss.
Patient Data
Inflated gastric balloon in the gastric antrum. The stomach is markedly distended and the esophagus is distended and fluid-filled. Large defect of the gastric body lesser curvature indicating perforation. Free intraperitoneal air adjacent to the stomach wall defect with a large amount of ascites. Reactive wall thickening of adjacent loops of small bowel.
Small hepatic cortical cysts segment VII. No calcified course stones in the gallbladder. The pancreas, spleen, adrenal glands appear unremarkable. Both kidneys are well perfused.
Lung bases remain clear. No suspicious focal bone abnormality.
Impression
Large gastric perforation of the lesser curvature of the gastric body. The gastric balloon is obstructing the gastric antrum causing obstruction. Fluid distended esophagus is a aspiration risk.
Case Discussion
The patient underwent emergency surgery. The surgical notes are:
Upper midline laparotomy
FINDINGS: 18 cm anterior/ lesser curve gastric perforation, not involving LOS but <2 cm distal to GEJ. 2 L+ gastric content, 4-quadrant contamination + food residue, underlying intact intra-gastric balloon.
Findings above. Total washout 19 L in, 20.5 L out + volume in sponges. The gastric balloon was retrieved intact. anterior gastrotomy closed in 2 layers 3-0 PDS with omental patch. Entire stomach, SB, LB viable. NG tube confirmed by palpation. 14 FR feeding jejunostomy placed LUQ, purse, Witzel tunnel, 4 quadrant box sutures and distal pexy in the usual fashion. 19 FR Blake drain X2, upper to gastrotomy closure, lower to the pelvis.
The patient has a relatively smooth post-operative recovery.
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