Buried Bumper Syndrome Leading to Peritonitis and Ileus

A 90-year-old woman presented to the author’s hospital with vomiting. Four years previously, she had undergone percutaneous endoscopic gastrostomy due to cerebral infarction. The patient’s abdomen was distended with tenderness and bowel sounds were absent. Abdominal radiography showed noticeable small intestinal gas (Picture 1). Computed tomography revealed a tube bumper outside of the stomach with a large amount of ascites (Picture 2) and no obvious intestinal obstruction. Gastroscopy confirmed that the bumper was not visible on the gastric wall (Picture 3). The patient was diagnosed with peritonitis and ileus caused by buried bumper syndrome (BBS). Informed consent for surgical intervention could not be obtained; thus, the migrated tube was removed after endoscopic clipping at the residual fistula. Antibiotics were administered in sufficient quantities and long tube decompression was performed. However, the patient died on the 12th day after admission. For the prevention of BBS, it is important to check whether a tube inserted several centimeters can rotate (1), especially in obese patients.