Early buried bumper syndrome: Bump it before you get buried.

Background: Buried Bumper Syndrome (BBS) is a condition resulting in the submucosal embedding of the per-cutaneous endoscopic gastrostomy tube bumper and a known long term complication of Percutaneous Endoscopic Gastrostomy (PEG) tube rendering the tube non-functional. This manuscript describes a case of BBS and discusses the role of appropriate incision technique and post incision care for the reduction of incidence of BBS among patients with a newly inserted PEG tube. Case Presentation: A fifty years old lady with recurrent Nasaopharyngeal Carcinoma presented with a localized neck abscess secondary to pahryngeo-pleural fistula. In view of the large collection size, a decision was made to divert the patient’s oral intake via a feeding gastrostomy to allow for healing of the fistula. A PEG tube was successfully inserted via endoscopic guidance. However, gastrostomy was complicated with localized tenderness surrounding the insertion site at one week post insertion. Further investigations revealed BBS which was treated successfully solely by a creative endoscopic approach. Fortunately, the patient was able to use the PEG tube actively for a short period to facilitate fistula healing and was subsequently removed after six months with no other complications. Conclusion: Good principles of insertion coupled with good post insertion care will contribute to the reduction in the incidence of BBS.