A Case of Buried Bumper Syndrome Complicating a Percutaneous Endoscopic Gastrostomy in a Child

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  • Komori Toshie
    Department of Pediatric Surgery, Niigata City General Hospital
  • Iinuma Yasushi
    Emergency and Critical Care Medical Center, Niigata City General Hospital
  • Nitta Koju
    Department of Pediatric Surgery, Niigata City General Hospital
  • Naito Shiniti
    Department of Pediatric Surgery, Niigata City General Hospital

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Other Title
  • バンパー埋没症候群を合併した小児PEGの1例
  • 症例報告 バンパー埋没症候群を合併した小児PEGの1例
  • ショウレイ ホウコク バンパー マイボツ ショウコウグン オ ガッペイシタ ショウニ PEG ノ 1レイ

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Abstract

A 9-year-old male, who was neurologically disabled due to cerebrovascular disease, underwent a Percutaneous Endoscopic Gastrostomy (PEG). PEG was carried out via the Pull method under general anesthesia. A 14Fr catheter (Neofeed-PEG Kit) was inserted at the anterior wall of the body of the stomach. No additional fixation procedure was carried out. The post-operative course was uneventful for three months. However, after this period, tube obstruction was observed during the injection of a liquid diet. Frequent vomiting after the injection also occurred. The endoscopic findings revealed that the intestinal bumper of the PEG catheter had been, for the most part, buried in the gastric mucosa and therefore a diagnosis of BBS was made. The endoscopic exchange of the catheter was impossible; therefore, a surgical regastrostomy was carried out. The post-operative course was uneventful and the patient was successfully weaned from the feeding via gastrostomy on POD181. Regarding the cause of BBS in this case, recurrent convulsion persisted before and after PEG. The medicinal management for such convulsions was difficult. Therefore, we speculate that excessive and persistent traction to the PEG catheter had most likely occurred and such traction might thus have caused BBS.

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