Vol 43 # 2 June 2011 - Kma.org.kw

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Buried Bumper Syndrome
June 2011
positioning the external bumper during daily cleaning.
The avoidance of external pulling and traction must
be emphasized, as excessive traction can accelerate
the development of BBS. Additionally, caregivers
must be trained to examine the PEG tube daily for any
leakage, tenderness or inability to push in the tube and
to consider the possibility of BBS, when any of these
signs are present, so that patient can be referred for
urgent endoscopy.
The treatment of BBS is varied and a number of
techniques have been described in the literature, which
were used to manage this syndrome and remove
the tube. The simplest one is basically by applying
gentle traction force to the tube in order to remove
it. Endoscopy is another option, which is commonly
used in such cases. However, if the buried tube cannot
be removed by manual or endoscopic methods as in
our case, or if the patient’s condition is complicated by
peritonitis or abscess surgical intervention with either
laparotomy or laparoscopy approach is needed [10] .
Ultrasound imaging (endoscopic US of the gastric wall
with a catheter probe) can provide helpful additional
information in deciding whether an endoscopic or
surgical approach should be attempted to remove the
PEG [11] .
CONCLUSION
Failure to recognize this syndrome may result in
serious complications including PEG tube infection,
perforation of the stomach, peritonitis, hemorrhage
and death. In this case, our patient was lucky and did
not develop peritonitis. Physicians should be aware of
this serious complication of PEG placement. BBS is not
so uncommon and some patients might have recurrent
episodes of BBS. The most common presentations are
difficulty feeding, peristomal leakage and fixation of
the feeding tube. Explicit and specific instructions
should be provided to the caregivers to prevent BBS.
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