title: Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper.
abstract: Two complications are reported from excessively taut application of percutaneous endoscopic gastrostomy (PEG) external bumpers against the abdominal wall skin. First, a 55-year-old woman status post PEG developed a gastric ulcer, complicated by acute gastric bleeding, directly underneath the internal gastric PEG bumper. This complication was associated with replacement by an unknown healthcare worker of the standard flexible external (cutaneous) PEG bumper with an unauthorized rigid external clamp (bumper) and with excessively taut application of this clamp against the abdominal wall skin. No other causes or risk factors for gastric ulcers were present. The pathophysiology of this ulcer, similar to that of a decubitus ulcer, appears to be mucosal ischemia and pressure necrosis. Second, a 37-year-old man status post PEG developed a buried internal gastric bumper that caused PEG malfunction and abdominal pain from excessively taut application of the external PEG bumper. These case reports should alert healthcare workers that replacing a flexible external bumper with a rigid one and that tightening the external bumper excessively may cause pressure necrosis manifesting either as gastric or cutaneous ulcers or as a buried internal bumper. This alert is particularly important for nurses as they are likely to be the first healthcare workers to notice or be told of PEG failure because of their close involvement in the day-to-day care of the patient and their typically close rapport with the patient's family.
authors.affiliation: Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cappell
authors.forename: Brett
authors.initials: B
authors.lastname: Inglis
authors.forename: Adam
authors.initials: A
authors.lastname: Levy
mesh_terms: D000328:Adult; D020878:Device Removal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications / Q000209:etiology / Q000451:nursing*; D005753:Gastric Mucosa / Q000293:injuries*; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013276:Stomach Ulcer / Q000209:etiology / Q000451:nursing*; D014143:Traction / Q000009:adverse effects; D016896:Treatment Outcome