title: The Challenging Buried Bumper Syndrome after Percutaneous Endoscopic Gastrostomy.
abstract: Buried bumper syndrome (BBS) is a rare complication developed after percutaneous endoscopic gastrostomy (PEG). We report a case of a 38-year-old male patient who sustained severe traumatic brain injury that was complicated with early BBS after PEG tube insertion. On admission, bedside PEG was performed, and 7 days later the patient developed signs of sepsis with rapid progression to septic shock and acute kidney injury. Abdominal CT scan revealed no collection or leakage of the contrast, but showed malpositioning of the tube bumper at the edge of the stomach and not inside of it. Diagnostic endoscopy revealed that the bumper was hidden in the posterolateral part of the stomach wall forming a tract inside of it, which confirmed the diagnosis of BBS. The patient underwent laparotomy with a repair of the stomach wall perforation, and the early postoperative course was uneventful. Acute BBS is a rare complication of PEG tube insertion which could be manifested with severe complications such as pressure necrosis, peritonitis and septic shock. Early identification is the mainstay to prevent such complications. Treatment selection is primarily guided by the presenting complications, ranging from simple endoscopic replacement to surgical laparotomy.
authors.affiliation: Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Afifi
authors.affiliation: Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zarour
authors.affiliation: Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Hassani
authors.affiliation: Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Ruben
authors.initials: R
authors.lastname: Peralta
authors.affiliation: Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
keywords: Buried bumper syndrome; Complication; Percutaneous endoscopic gastrostomy tube; Trauma; Treatment