The buried bumper syndrome: the usefulness of retrieval PEG tubes in its management

Percutaneous endoscopic gastrostomy is a safe and easy method and carries a low mortality and complication rate. The buried bumper syndrome is a rare and late complication of percutaneous endoscopic gastrostomy tube placement. An 80-year-old man with bilateral basal ganglia bleeding was unable to swallow safely and required tube feeding. A Flexiflo Inverta percutaneous endoscopic gastrostomy tube was successfully inserted by pull technique. One year later, he was readmitted to our clinic because of nonfunctioning tube and peristomal cellulites. Endoscopy demonstrated dimpling of the gastric mucosa on the anterior wall of the stomach. Abdominal computed tomography revealed the bumper to be buried in the abdominal wall. The tube was removed by external traction, without any abdominal incision, and a different site was used for the insertion of a new percutaneous endoscopic gastrostomy tube. No further problems were encountered over the follow-up period of nine months. As a result, the Flexiflo Inverta percutaneous endoscopic gastrostomy tubes with externally removable internal bumpers were found useful in the treatment of buried bumper syndrome, and the buried bumper was easily removed by external traction without any endoscopic or surgical methods.