Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy
(PEG) placement in which the internal bumper migrates from the gastric lumen and becomes
lodged in the gastric wall or other places along the gastrostomy tract [1]. Most cases of buried bumper syndrome occur in patients with PEG tubes that have
a mushroom-like round tip or a four-winged tip, as the relatively hard internal bumper
causes pressure necrosis and results in buried bumper syndrome more frequently [2]
[3]. So far as we are aware, there have been no previous reports on buried bumper syndrome
in patients with a balloon-tipped PEG tube. Since the fluid inside the balloon effectively
regulates the pressure, the possibility of developing buried bumper syndrome is lower
with a balloon-tipped tube [2]
[3].
A 77-year-old woman was hospitalized for pain around a PEG tube that had developed
5 days previously. Her caregiver noticed a purulent discharge from the PEG insertion
site. Thirteen months before, we had carried out a tube replacement and placed a balloon-tipped
PEG tube. She was able to infuse the feeding formula through the tube by herself.
There was food regurgitation through the PEG site during feeding. The caregiver reported
that she had pulled the tube habitually whenever she felt that the feeding rate decreased.
Around the PEG tube, a yellowish discharge and hyperemic granulation tissue were noticed
(Figure [1]), and a tender subcutaneous round mass was palpated. Abdominal computed tomography
showed that the balloon was buried in the abdominal wall (Figure [2 a]). At endoscopy, the internal bumper was not visible, but a small crevice with surrounding
mucosal elevation was noted at the presumed site of insertion (Figure [2 b]). The tube was cut below the balloon port and the water in the balloon was allowed
to flow outside. It was then possible to pull out the buried PEG tube without difficulty.
Figure 1 External view of the percutaneous endoscopic gastrostomy tube. A yellowish, thick,
pus-like discharge around the percutaneous endoscopic gastrostomy (PEG) tube and granulation
tissue with a surrounding hyperemic induration on PEG tube insertion site were noticed.
Figure 2 a Abdominal computed tomography, showing the balloon that was buried in the abdominal
wall and thickening of the left lateral abdominal wall with infiltration, suggesting
inflammation. b Nonvisualization of the internal bumper in the anterior wall of the lower gastric
body. A small crevice with a surrounding mucosal elevation and yellowish discharge
was noted at the presumed site of insertion.
This case suggests that excessive tension between the internal and external bumper
is a more important factor for developing buried bumper syndrome than the type of
internal bumper used.
Acknowledgment
Support for the preparation of this paper was received from Wonkwang University in
2004.
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