Laparoscopic management of a small bowel obstruction secondary to Elipse intragastric balloon migration: A case report.

INTRODUCTION: The Elipse™ intragastric balloon (IGB) for weight loss is a swallowable capsule that is filled with 550mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event. PRESENTATION OF CASE: A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO), and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient's recovery was uneventful and she was discharged on postoperative day 4. DISCUSSION: We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases. CONCLUSION: Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully.

Markers of inflammation in men with small abdominal aortic aneurysm.

BACKGROUND: Markers of inflammation and fibrin turnover are elevated in individuals with a large (>55 mm) abdominal aortic aneurysm (AAA). Fibrin degradation generates D-dimer, known to possess multiple proinflammatory effects, and levels are elevated during early AAA development. This study characterized the plasma inflammatory response during early AAA pathogenesis to determine the effect of D-dimer levels. METHODS: The study compared 75 men with a small AAA (range, 30-54 mm) with 90 age-, sex-, and race-matched controls. Plasma interleukin-6 (IL-6), complement C3, high-sensitivity C-reactive protein (hsCRP), fibrinogen, and D-dimer levels were measured. RESULTS: Mean levels of fibrinogen (2.92 vs 2.59 g/L; P = .003), hsCRP (2.07 vs 1.29 ng/mL; P = .005), and D-dimer (346.7 vs 120.2 ng/mL; P < .001) were higher in men with a small AAA. These markers correlated with maximum aortic diameter determined by ultrasound imaging. On multivariate analysis, D-dimer levels were elevated in AAA individuals independent of smoking, cardiovascular disease (CVD), atherosclerotic risk factors, and inflammatory parameters. Fibrinogen and hsCRP levels remained elevated after adjustment for these covariates but lost significance when D-dimer was added to the model. CONCLUSION: C-reactive protein and D-dimer levels are elevated during early AAA development. D-dimer levels are most tightly associated with AAA status, however, and may mediate the observed elevation in acute-phase reactants.

Raised plasma fibrinogen concentration in patients with abdominal aortic aneurysm.

A feature associated with abdominal aortic aneurysms (AAA) is the presence of intraluminal thrombi (ILT). Elevated plasma fibrinogen concentrations predict a greater risk of thrombosis. Therefore, the authors assessed the relationship between fibrinogen levels, AAA size, and ILT. An age- and sex-matched case-control study was conducted. Demographic data and plasma samples were obtained from 110 patients with AAA and 110 controls. All subjects had an abdominal ultrasound scan to determine the size of the aneurysm and the percentage of the ILT occupying the lumen. Plasma fibrinogen concentrations were measured by the Clauss method. Fibrinogen concentrations were significantly higher in patients with AAA than in controls (median: 2.89 vs 2.53 g/L; p<0.01). Patients with AAA who were current smokers had a larger median AAA size (4.50 vs 4.30 cm; p<0.04) and greater percentage of the ILT (40% vs 30%) than those who did not smoke. Fibrinogen was positively correlated with AAA size (r =0.323; p<0.01) and the percentage of ILT occupying the lumen (r =0.358; p<0.05). Fibrinogen levels were higher in the AAA group. The authors also demonstrated positive correlations between the AAA size, ILT, and fibrinogen concentration. Smoking was associated with larger aneurysms and ILT. Fibrinogen may be a useful marker to monitor the progression of AAA.