A Rare but Fatal Complication of PEG: Buried Bumper Syndrome (BBS)

Abstract

Buried Bumper Syndrome(BBS) is defined as migration of inner bumper (fixating internal part of PEG) along the stoma channel. The bumper may be partially covered by over-growth mucosa or completely dislodged outside the gastric wall. Complete BBS without visible part of inner pumper can be a challenge for endoscopic management. Here, we present a 72- year- old nursing home resident with complete BBS. A 72-year-old- nursing home male resident was sent from nursing home for a dislodged PEG tube. Past medical history was significant for type 2 diabetic mellitus, hypertension, stroke with left sided hemiparesis and dementia. PEG was placed in setting of advanced dementia and dysphagia from CVA 6 months ago. Vitals were stable. Labs were within normal references. On local examination, stoma showed signs of infection. The external pumper was more than 1 cm from the stoma and internal bumper was juxtaposed to the skin under the stoma cavity. Flushing of the PEG tube with normal saline elicited painful withdrawal of hands. CT abdomen showed the internal bumper of the PEG tube was located between the abdominal wall and anterior wall of the stomach compatible with buried bumper syndrome (Figure-1). Inner bumper was removed. Under appropriate antibiotics, another PEG reposition was performed without complication(Figure-2). The patient tolerated tube feeds and was disposed to nursing home. BBS can be presented with a symptomatic clinical triad- inability to insert food or liquids, loss of patency and peristomal leak. In our case, the patient was successfully managed with PEG tube reposition through guided wire via the original track without complications.3081_A Figure 1. CT abdomen showed the internal bumper of the PEG tube was located between the abdominal wall and anterior wall of the stomach (white arrow) compatible with buried bumper syndrome.3081_B Figure 2. New per-cutaneous endoscopic gastrostomy Tube(PEG)