We report a case of a patient who presented with an acute abdomen 2 days after the insertion of an intragastric balloon system and discuss in detail the advantages and drawbacks of these devices in the therapy of morbid obesity. A 43-year-old morbidly obese man was admitted to the department of surgery in shock with a 2-h history of severe diffuse abdominal pain and the initial diagnosis of visceral perforation. The patient had been subjected to intragastric placement of an inflatable balloon 48 h prior to his presentation. Abdominal exploration revealed the presence of a large linear perforation in the fundus of the stomach.