Clinical Case Summary
Background: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly used for long-term enteral nutrition in critically or chronically ill patients [1]. Buried bumper syndrome (BBS), a rare but serious complication, occurs when the internal bumper migrates along the stoma tract, leading to tissue ischemia, infection, and potential tube dysfunction [2,3]. BBS typically manifests around 18 months post-placement, with acute presentations exceptionally rare [4]. This case highlights an unusual early onset of BBS, emphasizing the importance of vigilant post-procedural care [5].
Case report: An 83-year-old male with multiple comorbidities, including progressive oropharyngeal dysphagia following cervical spine surgery, underwent PEG tube placement for enteral nutrition. Postoperatively, mild oozing was managed by tightening the bumper. Twelve days later, erythema and pressure necrosis were noted due to excessive tightness, prompting loosening. Three weeks post-placement, localized cellulitis developed and was treated with antibiotics. Two months postoperatively, the PEG tube became dysfunctional, and endoscopic evaluation revealed a partially buried bumper. A minimally invasive surgical approach, assisted endoscopically, was performed to extract the bumper and replace the tube with a balloon G-tube. The revised PEG tube functioned effectively, with no recurrence of complications.
Conclusion: This case underscores the importance of early recognition and management of BBS, even in the acute postoperative period [4,7]. Minimally invasive techniques, combined with proper bumper positioning and patient education, are crucial for preventing and managing this complication [3,6]. Vigilant monitoring of PEG sites and timely intervention can significantly reduce morbidity and improve outcomes in patients with BBS [2,7].
References
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- Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016;22(2):618–27.
- Pérez R, De La Serna C. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc. 2019;11(9):611–7.
- Pinho J, Libânio D, Pimentel-Nunes P, Dinis-Ribeiro M. The challenging acute buried bumper syndrome: A case report. GE Port J Gastroenterol. 2018;25(3):151–4.
- Satiya J, Marcus A. The buried bumper syndrome: A catastrophic complication of percutaneous endoscopic gastrostomy. Cureus. 2019;11(3):e4275.
- Maly O, Bichard P. Endoscopic management of buried bumper syndrome using a guidewire and external traction: a novel technique. Acta Gastro-Enterol Belg. 2023;86(1):13–6.
- Venu RP, Brown RD, Pastika BJ, Erikson LW. The buried bumper syndrome: a simple management approach in two patients. Gastrointest Endosc. 2002;56(4):582–4.
Disclosure
Dear Editors,
I, Evelyn Inga, hereby declare that I have no financial, professional, or personal conflicts of interest.
I affirm that I have no affiliations, financial interests, personal relationships, or commitments that could influence my impartiality in reviewing, conducting, or overseeing our study. Additionally, I confirm that I will uphold the highest ethical standards in compliance with institutional and federal regulations.
If any potential conflict arises, I will promptly disclose it to the United European Gastroenterology Association. Please let me know if any further documentation is required.
Sincerely,
Evelyn Inga, MD