The internal bumper of a percutaneous endoscopic gastrostomy (PEG) tube may become dislodged, resulting in the buried bumper syndrome (BBS).


After becoming dislodged, the inner bumper migrates into the abdominal wall somewhere below the skin.


Risk factors for the buried bumper syndrome:

(1) excessive tension or traction placed on the tube

(2) tissue necrosis adjacent to the tube due to excessive pressure

(3) small inner bumper on the tube

(4) sharp tapered flange on the tube

(5) hard plastic tube

(6) inadequate patient care

(7) chemical deterioration of the tube caused by gastric acid

(8) incorrect placement


Use of an introducer device with a balloon catheter is associated with a very low risk of BBS.


Clinical findings in a patient with BBS:

(1) abdominal pain (may go unreported if the patient is comatose or sedated)

(2) peritubular leakage (fluid may have a low pH)

(3) inability to infuse feedings through the tube

(4) easy clogging

(5) infection around the tube


An early sign may be an increase in the height of the tube above the skin by several millimeters.


Serious complications:

(1) internal leakage of gastric contents

(2) peritonitis

(3) sepsis


If the diagnosis is suspected it can be confirmed by:

(1) physical examination (palpating the bumper under the skin)

(2) endoscopy

(3) ultrasonography or other imaging modality


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