• Anas Kadah, Tawfik Khoury, and Wisam Sbeit.
• Department of Gastroenterology, Galilee Medical Center, Nahariya, affiliated with the Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
• Isr Med Assoc J. 2020 May 1; 22 (5): 315-319.

BackgroundBuried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear.ObjectivesTo evaluate the Seldinger technique for treatment of early BBS after PEG insertion.MethodsWe report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma.ResultsBuried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later.ConclusionsExternal replacement over guide wire should be considered in such cases.

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