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• W2913294877 abstract "Early buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tube placement, where inner bumper gets “buried” in the gastrocutaneous fistulous tract. BBS is usually a late complication (> 4 weeks of PEG placement). We present a case of early BBS, 2 weeks after PEG tube placement, where internal bumper embedded in subcutaneous fat just outside gastric wall. The patient underwent urgent endoscopic removal of the buried bumper with simple external traction, with successful placement of a new tube through the same tract. Early diagnosis and prompt management are of paramount importance to avoid an ominous outcome. A 48 year-old woman with persistent dysphagia after resection of jugular foramen Schwanomma was referred for PEG tube placement, which was done uneventfully with the external bolster placed at the 5-cm external mark. Post-procedure, patient continued to have leakage from around the tube, and 2 weeks later she was unable to infuse tube feeding or even water. On examination, vital signs were within normal and she had no signs of peritonitis. The PEG tube external bolster was noted at 5.5-cm external mark with mild surrounding erythema. Abdominal x-ray with contrast showed the tube to be just outside the stomach. CT scan of abdomen confirmed retraction of PEG tube's internal bumper into the subcutaneous fat just adjacent to the gastric wall (Figure 1). The patient was admitted to the ICU and within two hours; urgent endoscopic removal of the PEG tube was undertaken. On esophagogastroduodenoscopy (EGD), a hole was appreciated in the anterior wall of gastric body (Figure 2), and the PEG tube was removed externally with simple traction with little difficulty. A new 20-Fr PEG tube was placed through the same tract with the external bolster left at 4-cm external mark. The patient was discharged home in 2 days and on follow up in GI clinic, 7 weeks later, she was tolerating tube feedings well without further complications. Eleven cases of early BBS (≤ 4 weeks) have been described in the literature. Traction on the tube caused by inadvertent tugging, or extreme tightness of the external bolster has been attributed as a major cause. The classic symptoms constellation of BBS includes tube blockage, peri-tubal leakage, resistance to infuse feedings and abdominal pain. Several techniques have been described for management of BBS, including simple traction, endoscopic or surgical measures.Figure: Computed tomography of abdomen showing retraction of the PEG tube internal bumper into the subcutaneous fat adjacent to gastric wall.Figure: EGD showing PEG tube site with a hole at the anterior stomach wall.Table: Table. Demographics, Clinical presentation, Endoscopic/Surgical Management and Outcome of 11 Published Cases of Early (≤4 weeks) Buried Bumper syndrome (BBS)" @default.
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• W2913294877 date "2017-10-01" @default.
• W2913294877 modified "2023-09-25" @default.
• W2913294877 title "Early Buried Bumper Syndrome: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement" @default.
• W2913294877 doi "https://doi.org/10.14309/00000434-201710001-01831" @default.
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