Revision 6 for 'Buried bumper syndrome'

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Buried bumper syndrome

Buried bumper syndrome (BBS) is a rare but important complication in patients with percutaneous endoscopic gastrostomy (PEG) tube, occurring by migration of the internal bumper along its track. The tube may get lodged anywhere between the gastric wall and the skin and lead to life-threatening complications including peritonitis, hollow viscus perforation, abscess formation and necrosis.

Epidemiology

Reported incidence lies somewhere between 0.3 - 4% of patients. Most commonly seen as a late complication, it has been reported as early as 1 week after placement.  Not surprisingly, the risk of BBS varies between various models/types. 

Clinical presentation

Symptoms and signs may comprise 

  • simple PEG tube malfunction
  • leakage from peritubular areas
  • erythema and edema of the peritubular skin
  • abdominal pain
  • frank peritonitis

Pathology

 

Radiographics

Although the most sensitive test is considered to be endoscopy, allowing for both the diagnosis and possible treatment, imaging studies play a pivotal role both in suggesting the diagnosis and depict the degree of this potentially fatal complication.

Flouroscopy

Although upper gastrointestinal studies occasionally may suggest pneumoperitoneum and/or contrast leak from the tube, they have been shown to fail in diagnosing the entity and should not be part of the workup.

Ultrasound

may allow for assessing the location of the internal bumper and depict local or peritoneal collections.

CT

Treatment and prognosis

Practical points

  • Maintaining a high level of clinical suspicion of this potentially life-threatening complication may prove life-saving.
  • As such, cross-sectional imaging should be pursued/offered by the radiologist possibly even as first-line imaging.

 

 

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