Pediatr Gastroenterol Hepatol Nutr.  2019 Jan;22(1):86-89. 10.5223/pghn.2019.22.1.86.

Wire Guided Cannulation Facilitates Endoscopic Management of Buried Bumper Syndrome: A Novel Technique

• Peck J
• Sapp K
• Wilsey A
• Wilsey M

• KMID: 2430920
• DOI: http://doi.org/10.5223/pghn.2019.22.1.86

Abstract

Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of buried bumper syndrome and describe a novel technique for bumper removal in which we use a guide wire in combination with external traction to maintain a patent gastrostomy lumen while removing the internal percutaneous endoscopic gastrostomy bumper.

Keyword

Endoscopy; Pediatrics; Gastroenterology

MeSH Terms

Adolescent
Catheterization*
Comorbidity
Diagnosis
Endoscopy
Female
Gastroenterology
Gastrostomy
Hemorrhage
Humans
Necrosis
Pediatrics
Peritonitis
Sepsis
Traction

Figure

• 

  Fig. 1 Endoscopic bulge identified at percutaneous endoscopic gastrostomy tube site within the stomach.

• 

  Fig. 2 Guidewire successfully passed through existing percutaneous endoscopic gastrostomy tube from an external approach, allowing subsequent gastrostomy button placement.

Reference

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