Intragastric Balloon Rupture

A 38 year old obese female presented to the emergency department with 1 hour of nausea and blue colored urine. She endorsed recent flatus and bowel movement but denied abdominal pain, dysuria, fevers, or toxic ingestions. She presented a urine cup on arrival with obviously blue tinged urine (Figure). Her exam revealed a comfortable appearing female with no abdominal or costovertebral tenderness. She reported having an OrberaTM intragastric balloon placement 15 months prior in Brazil (Apollo Endosurgery, Inc., Austin, TX). The patient was admitted to the hospital for urgent endoscopic retrieval. However, as the device is not approved for use in the U.S., attempts to find a local physician familiar with the procedure or the appropriate retrieval equipment were unsuccessful. Open surgical removal was offered to the patient, who declined and instead returned to Brazil for removal there. The patient was lost to follow up.