Buried bumper syndrome, a rare and severe complication of percutaneous endoscopic gastrostomy: importance of early diagnosis in poststroke patients

Abstract

Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is considered a low-risk procedure; however, side effects may happen, the majority being of mild severity. Among the severe complications, few cases entitled “Buried bumper syndrome” (BBS) have been described. BBS corresponds to the migration of the internal fixation along the stoma tract, becoming lodged between the external wall of the stomach and the skin, which can be associated with local infection, peritonitis, and/or necrotizing fasciitis. Case description: On 06/03/2021 at 29 years old male patient, with no relevant medical history is admitted to the São João Hospital with an extensive midbrain and brainstem hemorrhagic lesion, shown on CT scan. The patient lost his oral route and ability to communicate. Due to severe dysphagia, a PEG was placed without immediate complications. 3 days later, the nursing team reported peri-stomal food losses and local inflammation, with the patient unable to verbalize any complaint. Although there was an adjustment of the PEG by the gastroenterologist, these reports recur for the next week, being detected by the medical team after a routine full body evaluation of the patient. After a new evaluation, a CT was performed, reporting “PEG, whose balloon is located between the median abdominal wall and the anterior surface of the left hepatic lobe”, compatible with the complication described as “buried bumper syndrome”. Discussion: The present case emphasizes the importance of correctly identifying the complications after undergoing PEG, as well as the risk factors and consequences associated with this syndrome, namely in patients with post-stroke status, whose communication is often compromised, and special attention must be given