Today´s radiographs belong to a 53-year-old man with abdominal pain.
What do you think?
showing today axial and coronal CI images of the abdomen. What do you think?
Click here to see the answer
Findings: PA and lateral chest radiographs show a large gastric bubble, with abundant stomach contents (A, arrow). In addition, there is a prominent air-fluid level in the right upper quadrant (A-B, red arrows), A small rounded metallic opacity is projected over it in the lateral view (B, circle).
The findings are suggestive of gastric outlet obstruction. Duodenal obstruction is unlikely because the second air-fluid level is anterior in the lateral projection. The little rounded metallic opacity suggests the possibility of a foreign object.
Coronal and axial CT show a food-filled stomach with a balloon located in the antrum (C-D, arrows).
Upright abdominal radiograph (E), parallels the gastric findings in the coronal CT (F).
(Showing plain film of the abdomen as an homage to Dr Genchi Bari).
A gastric balloon for obesity had been placed two weeks earlier.
Final diagnosis: balloon causing stomach outlet obstruction. This complication occurs in less than 1% of cases (*).
Congratulations to Olena, who was the only one to see the balloon valve and to Archanereddyt who made the final diagnosis.
Teaching point: as stated in case 242, always include iatrogenesis in your differential diagnosis. Reviewing the literature I discover an interesting fact: the saline in the balloons is tinted blue. If the urine becomes blue or green, is a sign of balloon deflation.
Incidentally, malicious rumors about the radiographs belonging to Miss Piggy are totally false!
(*) Gastric outlet obstruction secondary to orbera intragastric balloon. SA Kook and J Hammond. JSCR 2018; 10: 1-3