The “Buried Bumper Syndrome” (also abbreviated as “BBS”) is a late and uncommon complicating factor of PEG tubes that can lead to gastric perforation, bleeding, tube dysfunction, peritonitis, or even death. This syndrome emerges when the outer bumper of percutaneous endoscopic gastrostomy outer presses too hard against the abdominal wall. The bumper on the G-internal tube gradually recedes and is swallowed up by the expanding gastrostomy tract. The internal bumper becomes lodged in the gastric wall of the gastrostomy tract, causing localized swelling and erythema of the skin.
To sum up, acute BBS is an uncommon serious condition of PEG tube insertion that is linked to life-threatening complications like pressure necrosis, peritonitis, and septic shock. The key to avoiding such problems is prompt diagnosis.
Buried Bumper Syndrome Symptoms
An early sign of this syndrome is stoma-related nutrition or gastric content leakage. Signs of a local infection include redness, pain, and pus. If the cannula becomes fixed, further insertion will be impeded, but rotation is still possible.
Obstruction of the tube is a late sign that is sometimes restricted to aspiration (valve type) at first, but the buried bumper syndrome cannot be ruled out if the tube is still open. Rarely, the internal disc is seen protruding through the skin or felt just beneath the surface.
The classic triad of PEG tube complications includes insertion failure, patency breakdown, and leakage around the tube. The accidental discovery of buried bumper syndrome during gastroscopy for removal or other reasons is also possible.
Buried Bumper Syndrome Causes
Obesity is regarded as the single most significant risk factor for BBS, although numerous risk factors, including rapid weight gain, patient manipulation, gauze placement beneath the external bumper rather than over it, chronic cough, and tube manipulation by inexperienced staff, and malnutrition, are linked to this syndrome. It is known that BBS can develop over time if the tension on the tube is increased unnecessarily.
Some other factors that are associated with this buried bumper syndrome are:
- An abnormally high amount of pressure between the interior and exterior bumpers.
- Chronic malnutrition results in slow wound recovery.
Buried Bumper Syndrome Diagnosis
Endoscopy is the gold standard for diagnosing buried bumper syndrome because it allows one to directly observe the internal bumper buried within the gastric wall. The other method used to detect a displaced internal bumper is a CT scan. Because the gastrostomy tract remains open, the patient may go undiagnosed if fluoroscopy is performed through the PEG tube. Clinical testing is the first step in diagnosing BBS, and either endoscopy or computed tomography is used for confirmation.
Buried Bumper Syndrome Treatment
The main treatment for these patients is to remove the buried bumper, even if the patient has no symptoms. This is done to prevent further problems, like a hole in the stomach, peritonitis, and an infection of the subcutaneous tissue. Tubes are removed using a variety of in-body methods, such as surgery or an endoscopic snare inserted through the mouth. Sometimes, a collapsible internal bumper is used for easy external traction. Existing literature also describes alternative methods, such as angioplasty balloon dilator placement with radiological guidance, for restoring blood flow to the affected area.
The condition of the patient is improved through the administration of nutritional support as well as adjustments to fluid and electrolyte levels. After the infection has been contained at the tube site, it will be necessary to treat the wound and surrounding area with broad-spectrum antibiotics. Conservative treatment, surgical excision, and endoscopic repair are all viable options for managing Buried Bumper Syndrome. A proper patient choice and management strategy are also crucial factors in successful outcomes.