Acute Buried Bumper Syndrome

Khalil, Qasim; Kibria, Rizwan; Akram, Salma

doi:10.1097/smj.0b013e3181fa73d0

Cited by 23 publications

(17 citation statements)

References 8 publications

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“…A relationship is believed to exist between tightening of the external bolster in an effort to prevent leaking of gastric contents causing increased tension in the tube [3]. Other contributing factors include gastric acid alteration of the internal bumper, PEG tube characteristics such as a hard plastic composition, and inadequate patient care [11]. …”

Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

Biswas

Dontukurthy

Rosenzweig

et al. 2014

Case Reports in Critical Care

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Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

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Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

Biswas

Dontukurthy

Rosenzweig

et al. 2014

Case Reports in Critical Care

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“…The syndrome becomes apparent after 4 months of use, but time intervals as short as 6 days or as long as 7 years have been reported in the literature. 9,10 In some patients, epithelialization with coverage of the internal gastrostomy stoma with gastric mucosa can result in complete closure of the orifice. The burial level of the internal bumper and the stage of mucosal covering over the tube determine symptoms such as immobilization of PEG tube, inability to infuse feeding solutions through the tube, leak around the tube and abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

“…Tubes with small inner bumper, sharp tapered flange, and hard plastic composition may increase the risk of this complication. 9 Some methods have been described to prevent BBS. It is advised to allow an additional 1.5 cm between the external bumper of the PEG and the skin to minimize the risk of pressure necrosis.…”

Section: Discussionmentioning

confidence: 99%

Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

Akarsu¹,

Kantar²

2012

Turkiye Klinikleri J Med Sci

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ercutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Buried bumper syndrome (BBS) is one of the rare complications of PEG and occurs when internal bumper of the PEG tube becomes lodged anywhere between the gastric wall and the skin along the PEG tract. It is considered to be a late complication and becomes apparent months to years after PEG placement.1 Here, we report an unusual case of BBS with a gastric perforation at the internal gastrostomy site and peritonitis that occurred on the third day of placement. The contributing factors, preventive measures and treatment recommendations are also reviewed briefly. A AB BS ST TR RA AC CT T Percutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Here, we report a case of buried bumper syndrome, gastric perforation and peritonitis after PEG. In our case, perforated area was closed endoscopically by using hemoclips. The patient was treated with intravenous broad spectrum antibiotics for 10 days and fed by parenteral nutrition. The patient responded well to medical treatment therefore there was not any need for a surgical exploration. Follow up endoscopy was performed 15 days later which showed closure of the perforation area. A new PEG tube was inserted 1 month later.K Ke ey y W Wo or rd ds s: : Peritonitis; endoscopy, gastrointestinal Ö ÖZ ZE ET T Perkütan endoskopik gastrostomi (PEG) ağızdan gıda alımı yetersiz olan hastalarda geniş kabul görmüş bir işlemdir. Artan kullanımla birlikte PEG'in yan etkileri ve komplikasyonları da daha belirgin hale gelmektedir. Burada PEG'den sonra gelişen gömülmüş tampon sendromu, mide perforasyonu ve peritonit olgusunu sunuyoruz. Olgumuzda perfore alan hemoklipler kullanarak endoskopik olarak kapatıldı. Hasta 10 gün boyunca intravenöz geniş spektrumlu antibiyotiklerle tedavi edildi ve parenteral beslendi. Hasta medikal tedaviye iyi yanıt verdi, böylece cerrahi eksplorasyona gerek kalmadı. Onbeş gün sonra takip endoskopisi yapıldı ve perforasyon alanının kapandığı görüldü. Bir ay sonra yeni bir PEG tüpü yerleştirildi.A An na ah ht ta ar r K Ke el li im me el le er r: : Peritonit; endoskopi, gastrointestinal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (6 6) ): :1 17 79 91 1--5 5

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“…But, few documented reports of BBS occurring as soon as 5 to 30 days of PEG tube placement have been published in literature. [3] The postulated mechanism of BBS includes excessive tension between internal and external bolsters, leading to mucosal ischemia and pressure necrosis.…”

Section: Introductionmentioning

confidence: 99%