Gastric Balloon Complication Mimicking Acute Coronary Syndrome: A Case Report

Although intragastric balloons are a common endoscopic bariatric therapy, they carry a risk of complications, including obstruction and intolerance, which can lead to severe dehydration and metabolic disturbances. We present the case of a 40-year-old female with a history of ischemic cardiomyopathy and hypertension who presented to the emergency department with chest pain, abdominal pain, and repeated vomiting one month after gastric balloon insertion. Her initial workup was concerning for acute coronary syndrome, with EKG showing inferolateral ST-T depressions and a positive troponin. Further evaluation revealed severe acute kidney injury, metabolic alkalosis, and dehydration. The multidisciplinary team diagnosed sepsis and acute kidney injury due to severe dehydration from a suspected gastric outlet obstruction secondary to the balloon. Management involved fluid resuscitation, electrolyte correction, antibiotic therapy, and urgent endoscopic removal of the gastric balloon. Following removal, the patient's symptoms, EKG changes, and laboratory abnormalities resolved completely. This case highlights a critical diagnostic pitfall: metabolic and renal sequelae of gastric balloon complications can mimic non-ST-elevation myocardial infarction, potentially leading to misdirected care. A high index of suspicion for non-cardiac causes is essential in patients with bariatric devices to ensure timely and correct intervention.