title: Buried bumper syndrome causing rectus abdominis necrosis in a man with tetraplegia.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To enhance the early recognition of buried bumper syndrome in patients with tetraplegia requiring percutaneous endoscopic gastrostomy (PEG).
  
  
  METHODS
  Inpatient unit, Massachusetts, USA.
  
  
  METHODS
  A 44 year-old man with C2 American Spinal Injury Association grade A tetraplegia with a relatively recent PEG insertion secondary to poor nutritional intake.
  
  
  RESULTS
  Several months after PEG placement, patient became febrile, hypotensive and complained of abdominal pain. Plain films showed a dilated bowel suggestive of ileus. Abdominal and pelvic computed tomography with and without contrast revealed PEG tube dislodgement, and a 21 cm x 2.8 cm left anterior abdominal wall collection consisting of air and contrast. Upon surgical intervention, the left rectus abdominis sheath and muscle were found to be necrotic.
  
  
  CONCLUSIONS
  Buried bumper syndrome is a serious complication related to PEG tubes. For many people with tetraplegia, PEG is a life-saving procedure with minimal risks. However, emergencies do occur, making prompt recognition imperative to prevent a fatal sequela.
authors.affiliation: Spinal Cord Injury, VA Boston Healthcare System/Harvard Medical School, 1400 VFW Pkwy, SCI-128, West Roxbury, MA 02132, USA. tova.johnson@va.gov
authors.forename: T
authors.initials: T
authors.lastname: Johnson
authors.forename: K A
authors.initials: KA
authors.lastname: Velez
authors.forename: E
authors.initials: E
authors.lastname: Zhan
mesh_terms: D000328:Adult; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000150:complications; D006801:Humans; D008297:Male; D009336:Necrosis / Q000150:complications / Q000209:etiology*; D011782:Quadriplegia / Q000451:nursing; D017568:Rectus Abdominis / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods