Early Buried Bumper Syndrome: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

Abstract

Early buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tube placement where the internal bolster gets "buried" in the gastrocutaneous fistulous tract. BBS is usually a late complication with onset > four weeks of PEG placement. We present a case of early BBS presenting at day 17 after PEG tube placement where the internal bolster got embedded in the subcutaneous fat just outside the gastric wall. The patient underwent urgent endoscopic removal of the buried bumper with the simple external traction, followed by the successful placement of a new tube through the same tract. Early diagnosis and prompt management are of paramount importance to avoid an ominous outcome.

Keywords: buried bumper syndrome; dysphagia; egd; peg tube placement.

Figure 1. CT scan of the abdomen without contrast showing retraction of the internal bolster of the percutaneous endoscopic gastrostomy tube (solid white arrow) into the subcutaneous fat adjacent to the gastric wall.

Figure 2. Endoscopic image showing percutaneous endoscopic gastrostomy tube site with a hole (solid white arrow) in the anterior stomach wall.

Figure 3. Endoscopic image showing a trocar that was introduced through the original gastrostomy orifice to place a new percutaneous endoscopic gastrostomy tube.