Buried bumper syndrome: a case report of an early PEG gastropexy-associated complication in a patient with gastric volvulus

Abstract

Buried bumper syndrome (BBS) is a rare complication associated with percutaneous endoscopic gastrostomy (PEG) tubes. It develops when the internal bumper migrates through the gastric wall, lodging anywhere along the gastrostomy tract leading to overgrowth of gastric mucosa thereby encasing the tube. BBS can lead to bleeding, perforation, peritonitis and intra-abdominal sepsis. Our case is a 71-year-old female presenting with tenderness, erythema and purulent discharge at the PEG tube site 2-weeks post-insertion. Computer tomography scan demonstrated the PEG had dislodged with the internal bumper in the subcutaneous tissue and the distal tip lying within the tract beyond the stomach wall. The PEG was removed by simple external traction. The patient clinically improved and discharged home on day three. Although BBS usually occurs late post-PEG insertion, it can also occur acutely. Preventative measures should be adopted at ward-level and emphasized with appropriate PEG tube care information provided to patients to avoid and recognize such complication.

Acute Buried Bumper Syndrome: A Case Report

“…Rarely, a PEG may be used for gastropexy [ 6 ]. Children with malabsorption disorders from cystic fibrosis or tracheoesophageal fistulas also benefit from PEG feeding [ 13 ].…”

“…BBS is a rare but serious complication of PEG tube feeding [ 1 , 3 , 6 ]. The median period for the development of BBS is 18 months [ 5 ].…”

“…BBS is a clinical diagnosis, but an EGD or abdominal CT scan may be used for confirmation. Imaging also helps ascertain the depth and location of the displaced bumper [ 6 ]. BBS diagnosis is often delayed in non-verbal or asymptomatic patients, and provider education can lead to a prompt diagnosis.…”

“…A percutaneous endoscopic gastrostomy (PEG) tube is a standard feeding modality for patients requiring long-term enteral feeding support [1,2], and its use has been increasing since the 1980s [3][4][5]. Buried bumper syndrome (BBS) is a rare but serious long-term complication of PEG tube feeding [6][7][8] and has a prevalence of 1.5% to 9% [2,6]. A PEG tube usually lasts up to 1-2 years, and tube degradation often indicates replacement [9,10].…”

“…In BBS, an internal bolster of the PEG tube migrates along the stoma tract and gets lodged anywhere between the gastric mucosa and the abdominal wall [3,6,[11][12][13]. The tight positioning of the external bumper is thought to cause a traction force, which displaces the internal bolster into the gastric wall.…”