Encephalopathy and high anion gap metabolic acidosis: an unusual herald of buried bumper syndrome

Lopez, Eric Mark J; Ghetmiri, Ehsan; Gettle, Lori Mankowski; Reed, Michael F.; McAllister, Brian P.

doi:10.1016/s0140-6736(15)60030-7

Cited by 1 publication

(1 citation statement)

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“…BBS may present with bleeding, perforation [1], peritonitis, abscess and phlegmon [7], but also, rarely, as necrotizing fasciitis [11], rectus abdominis necrosis [12], or with co-existence of encephalopathy and high anion gap metabolic acidosis [13]; these complications could be potentially lethal. Microbes isolated from the tube or the wound are rarely described in the literature, but they can include Klebsiella pneumonia and Candida vulgaris [7].…”

Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome: A Case Report of a Rare Complication of Percutaneous Endoscopic Gastrostomy

et al. 2016

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Percutaneous endoscopic gastrostomy (PEG) is thought to be a, relatively, safe procedure with a low rate of complications. Buried bumper syndrome (BBS) is the migration of the internal fixation device of PEG (bumper) out of the stomach and consists of a major and, usually, late complication with potentially lethal results. We present a case of such complication resulting in an extended anterior abdominal wall necrosis. An 87-year-old woman with a PEG placement 6 months before, due to Alzheimer's disease and inability of oral feeding, presented in a severe septic condition and with necrotic inflammation of the abdominal wall. Computerized tomography confirmed the migration of internal bumper subcutaneously. Excision of the gastrostomy and surgical debridement was performed, but, due to the patient's deteriorated condition, she died after 24 hours. PEG is ideal for patients with swallowing deficiencies, but severe complications may occur. Prevention and initiate diagnosis of the BBS are important for an early treatment, in order to avoid such severe complications.

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