title: Small bowel obstruction caused by intraluminal migration of retained percutaneous endoscopic gastrostomy internal bumper.
abstract: BACKGROUND
  Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut.
  
  
  METHODS
  A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation.
  
  
  RESULTS
  Due to migration of the retained flange, the patient developed small bowel obstruction.
  
  
  CONCLUSIONS
  Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.
authors.affiliation: Department of Surgery, Glan Clwyd Hospital, Rhyl, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Agaba
authors.forename: S S
authors.initials: SS
authors.lastname: Sarmah
authors.forename: B A
authors.initials: BA
authors.lastname: Victor Babu
authors.forename: P O
authors.initials: PO
authors.lastname: Agaba
authors.forename: O
authors.initials: O
authors.lastname: Ajayi
authors.forename: M
authors.initials: M
authors.lastname: Fayaz
authors.forename: B
authors.initials: B
authors.lastname: Ramanand
mesh_terms: D000368:Aged; D020878:Device Removal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D011859:Radiography; D013525:Surgical Instruments