Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

Abstract

ercutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Buried bumper syndrome (BBS) is one of the rare complications of PEG and occurs when internal bumper of the PEG tube becomes lodged anywhere between the gastric wall and the skin along the PEG tract. It is considered to be a late complication and becomes apparent months to years after PEG placement.1 Here, we report an unusual case of BBS with a gastric perforation at the internal gastrostomy site and peritonitis that occurred on the third day of placement. The contributing factors, preventive measures and treatment recommendations are also reviewed briefly. A AB BS ST TR RA AC CT T Percutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Here, we report a case of buried bumper syndrome, gastric perforation and peritonitis after PEG. In our case, perforated area was closed endoscopically by using hemoclips. The patient was treated with intravenous broad spectrum antibiotics for 10 days and fed by parenteral nutrition. The patient responded well to medical treatment therefore there was not any need for a surgical exploration. Follow up endoscopy was performed 15 days later which showed closure of the perforation area. A new PEG tube was inserted 1 month later.K Ke ey y W Wo or rd ds s: : Peritonitis; endoscopy, gastrointestinal Ö ÖZ ZE ET T Perkütan endoskopik gastrostomi (PEG) ağızdan gıda alımı yetersiz olan hastalarda geniş kabul görmüş bir işlemdir. Artan kullanımla birlikte PEG'in yan etkileri ve komplikasyonları da daha belirgin hale gelmektedir. Burada PEG'den sonra gelişen gömülmüş tampon sendromu, mide perforasyonu ve peritonit olgusunu sunuyoruz. Olgumuzda perfore alan hemoklipler kullanarak endoskopik olarak kapatıldı. Hasta 10 gün boyunca intravenöz geniş spektrumlu antibiyotiklerle tedavi edildi ve parenteral beslendi. Hasta medikal tedaviye iyi yanıt verdi, böylece cerrahi eksplorasyona gerek kalmadı. Onbeş gün sonra takip endoskopisi yapıldı ve perforasyon alanının kapandığı görüldü. Bir ay sonra yeni bir PEG tüpü yerleştirildi.A An na ah ht ta ar r K Ke el li im me el le er r: : Peritonit; endoskopi, gastrointestinal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (6 6) ): :1 17 79 91 1--5 5