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You are seeing a 2-year-old girl that had a PEG gastrostomy tube placed 1.5 years ago. The parents have noticed resistance when pushing in the bolus feeds, as well as increased leakage around the stoma site. The child seems to have pain and tenderness in the peristomal area, although there is no fever, redness, or purulent discharge. The tube is difficult to move or rotate.
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April 23, 2024 at 8:44 pm
C) Buried bumper syndrome
Buried bumper syndrome is a complication of PEG gastrostomy tubes where the internal bumper erodes and migrates into the gastric mucosa and can become completely buried in the gastric mucosa. It can occur early after tube placement but tends to be a later complication. Pulling hard on the tube increases risk. Symptoms such as resistance to infusion, leakage, and induration at the stomal site, abdominal pain, and difficulty moving or rotating the tube raise suspicion for buried bumper syndrome. Diagnosis is confirmed through direct visualization with endoscopy.