A female patient in her 30s with a history of sleeve gastrectomy and subsequent Roux-en-Y gastric bypass developed severe epigastric pain 72 hours after intragastric balloon placement. Imaging and upper gastrointestinal endoscopy revealed gastric perforation due to misplacement into the gastric pouch remnant. Emergency laparoscopic intervention confirmed necrosis and chemical peritonitis, necessitating balloon removal, peritoneal lavage, drainage and broad-spectrum antibiotics. Despite initial management, she required a second surgical lavage and intensive care for supportive treatment. Six weeks postsurgery, imaging confirmed complete recovery, and the patient remained asymptomatic. This case underscores the life-threatening complications of gastric balloons in post-bariatric surgery patients, emphasising the importance of strict adherence to contraindication guidelines and early imaging for accurate diagnosis and management.