Buried Bumper Syndrome
Left: Mucosal defect on the anterior gastric wall in a 54 year-old woman with a longstanding "button"-type gastrostomy device. After several months of uneventful daily use of the gastrostomy, the patient began to complain of discomfort at the gastrostomy site, and caretakers reported leakage from the gastrostomy site and resistance when infusing feeding. Externally, there was no erythema or purulent drainage. Endoscopy confirmed the suspicion of buried bumper syndrome: the internal bumper had migrated into the gastric wall and was no longer visible endoscopically.
Right: Close-up view of the same patient. A trickle of thin purulent fluid can be seen.
Internal portion of gastrostomy tube is partially embedded in the gastric wall of a 66 year-old woman who had undergone percutaneous endoscopic gastrostomy placement two weeks earlier.
Left: Mucosal swelling of the anterior gastric wall, indicating migration of the internal bumper of a feeding gastrostomy tube into
the gastric wall. A small residual tract remained in the mucosal The tube had reportedly been in place for two years. The patient had been
brought for simple gastrostomy tube change, but manipulation of the tube suggested buried bumper syndrome, and the tube could not be extracted with simple traction because it was
not a traction-removable type.
Center: A portion of the buried internal bumper could be seen by gently inserting the instrument tip into the remaining tract in
the mucosal defect. The entire bumper could not be seen, and could not be extracted endosopically.
Right: The internal bumper having been removed surgically.
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