Early Presentation of Buried Bumper Syndrome
A 76-year-old woman presented to the emergency department (ED) because of pain and drainage at her percutaneous endoscopic gastrostemy (PEG) tube site and inability to instill fluid. Three weeks prior, she had undergone a laryngectomy for recurrent laryngeal cancer. At the same time she had a tracheostomy and PEG performed. Three hours prior to arrival, she noticed peritubal leakage and localized discomfort with attempts to flush the tube. She denied prior complications with the tube.\nOn examination, the patient had normal vital signs and appeared comfortable. Her head, chest, and extremity exams were normal. Her neck showed a well-healing surgical incision. Her abdomen was soft with no appreciable tenderness. There was no evidence of distention or palpable masses. The patient’s PEG site was not indurated and showed no erythema or drainage. The external bolster was approximately 1 centimeter from the skin surface. The tube was not mobile within the stoma.\nAttempts to flush the tube with warm water and then soda resulted in peritubal leakage. It also caused the patient sharp, instantaneous abdominal pain at the site of the PEG. When the provider palpated the PEG site during flushing, transient distention and gurgling was felt within the abdominal wall.\nA tube study was performed. Based on this study, a computed tomography (CT) was performed () to determine the exact location of the PEG tube as well as any secondary complications resulting from its misplacement.\nGeneral surgery was consulted for the malfunctioning PEG tube. The surgical attending recognized this as “Buried Bumper Syndrome,” an uncommon and dangerous complication of PEG tube placement. The patient was admitted to the hospital for intravenous (IV) antibiotics and fluid hydration. Her PEG tube was removed operatively and was not replaced.