Buried bumper syndrome causing rectus abdominis necrosis in a man with tetraplegia.
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.
Johnson
T
T
Spinal Cord Injury, VA Boston Healthcare System/Harvard Medical School, 1400 VFW Pkwy, SCI-128, West Roxbury, MA 02132, USA. tova.johnson@va.gov
Velez
K A
KA
Zhan
E
E
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