Clinical Practice and Cases in Emergency Medicine

Case presentation: A 29-year-old woman presented to the emergency department three months after intragastric balloon placement with nausea, vomiting, constipation, and abdominal pain. Computed tomography (CT) demonstrated spontaneous deflation and migration of the device into the small bowel with resultant mechanical small bowel obstruction. The patient was managed conservatively with bowel rest, intravenous fluids, electrolyte repletion, and nasogastric decompression. Repeat CT on hospital day 2 confirmed distal migration of the balloon into the descending colon with interval decompression of the small bowel. On hospital day 3, the patient reported spontaneous passage of the balloon per rectum with complete resolution of symptoms.

Discussion: Spontaneous deflation and distal migration of an intragastric balloon causing small bowel obstruction is a rare but potentially life-threatening complication. Most reported cases require surgical or endoscopic intervention. This case highlights spontaneous transanal passage as a rare but favorable outcome achievable with conservative management in carefully selected, hemodynamically stable patients without signs of peritonitis, bowel ischemia or perforation, or failure of the intragastric balloon to progress.