Buried bumper syndrome causing rectus abdominis necrosis in a man with tetraplegia

Johnson, Tova; Velez, Kareen A.; Zhan, Ellen H

doi:10.1038/sc.2009.67

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…17 18 However, more severe presentations of this complication may occur, such as the appearance of fistulas or necrotizing fasciitis, and these are presentations often due to the inability of the patients to manifest symptoms early due to their age or due to their clinical condition. 19 The complications associated with BBS include perforation, peritonitis, 6 20 21 abdominal wall bleeding, 22 23 and abdominal wall abscess, 24 as well as necrosis secondary to pressure and gastric ulcers. 25…”

Section: Discussionmentioning

confidence: 99%

Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases

Devia

Santivañez

Rodriguez³

et al. 2019

Surg J

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Buried bumper syndrome (BBS) was described as a complication of percutaneous endoscopic gastrostomy (PEG) that occurs when the internal stump of the probe migrates and is located between the gastric wall and the skin. The increase of compression between the internal stump and the external stump of the gastrostomy tube causes pain and the inability to feed. We present the cases of three patients with BBS managed by the metabolic and nutritional support department. These cases intend to illustrate one of the less frequent complications of PEG, clinical presentation, risk factors, diagnosis, and especially clinical management. Although there are no defined gold standards for its management, the most important points in the management of this condition are early recognition, recommendations to avoid ischemic process at the moment of the insertion of the tube, specific care of the gastrostomy tube, and a periodic nutrition evaluation to avoid overweight, which causes traction and excessive pressure in the gastric wall. It is important for physicians to be aware of the recommendations to prevent BBS and its complications, especially in patients in whom communication can be difficult secondary to their pathologies and comorbidities.

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Section: Discussionmentioning

confidence: 99%

Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases

Devia

Santivañez

Rodriguez³

et al. 2019

Surg J

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“…BBS may present with bleeding, perforation [1], peritonitis, abscess and phlegmon [7], but also, rarely, as necrotizing fasciitis [11], rectus abdominis necrosis [12], or with co-existence of encephalopathy and high anion gap metabolic acidosis [13]; these complications could be potentially lethal. Microbes isolated from the tube or the wound are rarely described in the literature, but they can include Klebsiella pneumonia and Candida vulgaris [7].…”

Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome: A Case Report of a Rare Complication of Percutaneous Endoscopic Gastrostomy

et al. 2016

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Percutaneous endoscopic gastrostomy (PEG) is thought to be a, relatively, safe procedure with a low rate of complications. Buried bumper syndrome (BBS) is the migration of the internal fixation device of PEG (bumper) out of the stomach and consists of a major and, usually, late complication with potentially lethal results. We present a case of such complication resulting in an extended anterior abdominal wall necrosis. An 87-year-old woman with a PEG placement 6 months before, due to Alzheimer's disease and inability of oral feeding, presented in a severe septic condition and with necrotic inflammation of the abdominal wall. Computerized tomography confirmed the migration of internal bumper subcutaneously. Excision of the gastrostomy and surgical debridement was performed, but, due to the patient's deteriorated condition, she died after 24 hours. PEG is ideal for patients with swallowing deficiencies, but severe complications may occur. Prevention and initiate diagnosis of the BBS are important for an early treatment, in order to avoid such severe complications.

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“…Esophageal distension triggered pain in patients with cervical spinal cord transsection, which could be partly confounded by the more rostral projections of spinal esophageal afferents innervating the proximal esophagus [30]. Acute illnesses from appendicitis to cholecystitis may be more difficult to diagnose, but are still associated with abdominal pain in paraplegic individuals with thoracic or cervical lesions [31][32][33]. A case series of patients with complete spinal transsection at the level of the cervical cord (around C4) reported prolonged episodes of impaired gastric function after elective abdominal surgeries, typically manifesting with pain, bloating, nausea, and the inability to tolerate oral intake, a symptom complex similar to that described by our patient [34].…”

Section: Discussionmentioning

confidence: 99%

Pain without nociception?

Levinthal

Bielefeldt²

2012

European Journal of Gastroenterology & Hepatology

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We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain.

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Buried bumper syndrome causing rectus abdominis necrosis in a man with tetraplegia

Cited by 5 publications

References 3 publications

Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases

Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases

Buried Bumper Syndrome: A Case Report of a Rare Complication of Percutaneous Endoscopic Gastrostomy

Pain without nociception?

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