Beyond the weight loss: revisiting small bowel obstruction as an underestimated risk of intragastric balloons

Intragastric balloons (IGB) are a minimally invasive, reversible method for weight reduction in obese patients who fail conservative therapy but do not qualify for bariatric surgery. Despite their safety profile, rare yet severe complications can occur, such as small bowel obstruction (SBO) due to balloon migration. We present a case of a 37-year-old woman who developed SBO one year after gastric balloon placement, following successful weight loss. Imaging revealed a migrated balloon obstructing the jejunum, which required surgical extraction via enterotomy. This report compares our case with previously documented events, highlighting the clinical presentation, diagnostic challenges, and therapeutic decision-making. Although reported rates of obstruction remain below 0.2%, migration may occur months after the expected balloon excretion period. Persistent vigilance is required even long after IGB therapy. A stepwise diagnostic and management algorithm is proposed to guide clinicians facing this rare but potentially life-threatening complication.