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

OUP accepted manuscript

Percutaneous gastrostomy (PEG) tube placement is often the preferred approach to addressing nutritional deficits in patients requiring long-term feeding access. Numerous major and minor complications may occur with PEG tube insertion; buried bumper syndrome is a rare, long-term outcome of PEG tube placement, comprising <2.4% of complications. We present the case of a 60-year-old female with laryngeal cancer whom developed acute buried bumper syndrome after PEG tube insertion which was managed successfully with surgical intervention.

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

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.

An Early Presentation of Buried Bumper Syndrome

Percutaneous endoscopic gastrostomy (PEG) is a well-established and successful method of nutritional delivery. Complications, although rare, are divided into early or late. Buried bumper syndrome (BBS) is usually a late complication of PEG tube insertion and can cause many issues such as pressure necrosis, peritonitis, and septic shock. Endoscopic evaluation is the definitive diagnosis, and treatment depends on each patient and the degree of depth of disc migration. We present to you a case of buried bumper syndrome in a 66-year-old female that was initially thought to be complicated with peritonitis, and surprisingly occurring only one week after initial PEG tube placement.