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Management of a complication of percutaneous gastrostomy in children
Rashmi Roshan Singh1, Simon Eaton, Kate M Cross
1Department of Surgery, Institute of Child Health, London, United Kingdom. Tkumar@mercydesmoines.org
Insights
Buried bumper syndrome, a complication of percutaneous gastrostomy, can be prevented with adequate postoperative care. Management options include endoscopic removal or laparoscopic surgery.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Interventional Radiology
Background:
- Buried bumper syndrome is a rare complication of percutaneous gastrostomy where the internal flange erodes into the gastric wall.
- This complication is often associated with inadequate postoperative care and lack of gastrostomy tube mobilization.
- Understanding the management strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the management of buried bumper syndrome, a complication of percutaneous gastrostomy.
- To identify factors contributing to the development of buried bumper syndrome.
- To assess the effectiveness of different treatment modalities.
Main Methods:
- Retrospective analysis of a surgical and interventional radiology database from August 1999 to May 2011.
- Inclusion of 2,007 patients who underwent percutaneous gastrostomy insertion.
- Review of patient records and telephonic interviews with parents to assess pre-episode gastrostomy care.
Main Results:
- Twenty children (1%) developed buried bumper syndrome, primarily with neurological, metabolic, or endocrine disorders.
- Symptoms included leakage, site discharge, and feeding difficulties; 50% were asymptomatic.
- Interventional radiology removal was rarely successful; endoscopic removal (4/19) or surgical intervention (laparotomy/laparoscopy for 15/19) was often required.
Conclusions:
- Buried bumper syndrome is a rare but preventable complication of percutaneous gastrostomy.
- Inadequate postoperative care and insufficient tube mobilization are significant contributing factors.
- Endoscopic removal is a viable option, with laparoscopic surgery considered for refractory cases.
Aim:
"Buried bumper" is a complication of percutaneous gastrostomy related to the internal flange getting buried into the wall of the stomach. The aim of this study is to evaluate the management of this complication.
Methods:
The surgical and interventional radiology database in our hospital from August 1999 to May 2011 was analyzed. There were 2,007 patients who underwent percutaneous gastrostomy insertion. Notes for patients with buried bumper were reviewed. A telephonic interview with the parents of these children was performed with focused assessment of the care of the gastrostomy tube before the episode of buried bumper. Continuous data are reported as median (range).
Results:
Twenty children developed buried bumper after gastrostomy insertion. They had a primary diagnosis of neurological (n = 14), metabolic (n = 3), or endocrine (n = 3) disorders. The age at presentation was 5.7 years (2 to 18 years); 2.5 years (1 month to 5 years) after gastrostomy insertion. Ten children (50%) presented with symptoms related to buried bumper which included leakage around the gastrostomy (n = 4), pus, discharge or bleeding from the site (n = 5), stiffness on feeding (n = 3), and unable to push the flange (n = 1) (three children had more than one symptom). Ten children (50%) were asymptomatic and underwent routine change or removal of gastrostomy. In nine children, there was an attempt to remove the flange by interventional radiology but this was successful only in one. In the remaining 19 children, 4 had endoscopic removal while 15 children developed an inflammatory mass and required a laparotomy (n = 12) or laparoscopic-assisted excision (n = 3).
Conclusion:
Buried bumper is a rare complication of percutaneous gastrostomy. Inadequate postoperative care without appropriate mobilization is a factor leading to this preventable complication. Endoscopic removal is possible, failing which laparoscopic surgery should be considered.
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