PEG reimplantation after Buried Bumper Syndrome: a case report.

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Fabiola Fornaroli
Noemi Gualandi
Francesca Vincenzi
Luigi Laghi
Gian Luigi de'Angelis
Federica Gaiani


Percutaneous Endoscopic Gastrostomy, Buried Bumper Syndrome, Complication, Cellulitis, Enteral nutrition


Percutaneous endoscopic gastrostomy (PEG) is the method of choice to provide long-term enteral nutrition for patients with impossibility to be fed orally.

Although it is considered a routine and safe procedure, potential complications exist, which are generally classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use, such as buried bumper syndrome (BBS). BBS is a life-threatening complication, occurring in 0.3% to 2.5% of cases. Additional complications related to BBS may present, such as wound infection, peritonitis, and necrotizing fasciitis. Once resolved the acute complication, an adequate feeding method should be prompted for the patient, among whom PEG remains of choice. After tissue inflammation, fibrosis may prevent a standard endoscopic procedure for the new implantation, therefore endoscopists should modulate procedures to obtain successful and safe results. A combined surgical- and endoscopic strategy could resolve implantation difficulties ensuring a safe and simple procedure.We present here a case of BBS complicated with abdominal wall cellulitis in a paraplegic 35-year-old-man who was admitted to our hospital.


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1. Committee AT, Enestvedt BK, Jorgensen J, Sedlack RE, Coyle WJ, Obstein KL, Al-Haddad MA, Christie JA, Davila RE, Mullady DK, et al: Endoscopic approaches to enteral feeding and nutrition core curriculum. Gastrointest Endosc 2014, 80:34-41.
2. Arvanitakis M, Gkolfakis P, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, et al: Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021, 53:81-92.
3. Fascetti-Leon F, Gamba P, Dall'Oglio L, Pane A, de Angelis GL, Bizzarri B, Fava G, Maestri L, Cheli M, Di Nardo G, et al: Complications of percutaneous endoscopic gastrostomy in children: results of an Italian multicenter observational study. Dig Liver Dis 2012, 44:655-659.
4. Gkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, et al: Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021, 53:178-195.
5. Cyrany J, Rejchrt S, Kopacova M, Bures J: Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol 2016, 22:618-627.
6. Khalil Q, Kibria R, Akram S: Acute buried bumper syndrome. South Med J 2010, 103:1256-1258.
7. Biswas S, Dontukurthy S, Rosenzweig MG, Kothuru R, Abrol S: Buried bumper syndrome revisited: a rare but potentially fatal complication of PEG tube placement. Case Rep Crit Care 2014, 2014:634953.
8. Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F: Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997, 13:520-523.
9. Bystritsky R, Chambers H: Cellulitis and Soft Tissue Infections. Ann Intern Med 2018, 168:ITC17-ITC32.
10. Dhannoon A, AlKhattab M, Sehgal R, Collins CG: Buried bumper syndrome: a case report of an early PEG gastropexy-associated complication in a patient with gastric volvulus. J Surg Case Rep 2021, 2021:rjab261.
11. Bender JS: Percutaneous endoscopic gastrostomy placement in the morbidly obese. Gastrointest Endosc 1992, 38:97-98.
12. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT: Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014, 20:7739-7751.

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