# Buried Bumper Syndrome With Full Gastric Wall Penetration Managed With Delayed Replacement: A Conservative Approach

## TL;DR

A 21-year-old man with a rare condition had a serious gastrostomy tube complication, which was managed without surgery by delaying tube replacement to allow healing.

## Contribution

The paper introduces a conservative, non-surgical approach using delayed tube replacement for buried bumper syndrome.

## Key findings

- The patient's tube was successfully removed and replaced after an eight-day delay for mucosal healing.
- Proton pump inhibitors were used during the healing period to aid recovery.
- This approach avoided the need for surgery in a complex case of buried bumper syndrome.

## Abstract

Buried bumper syndrome is an uncommon but serious complication of gastrostomy tube placement, in which the internal bumper migrates into the gastric wall or beyond. Complications include bleeding, perforation, peritonitis, and death. We present a case of a 21-year-old man with Batten disease who presented with abdominal pain, swelling, and leakage from his gastrostomy tube. Imaging revealed that the balloon had advanced through the gastric wall, and an endoscopy was performed. Endoscopic examination revealed buried bumper syndrome with full gastric wall penetration. The tube was removed, and replacement was delayed for eight days to allow mucosal healing, with proton pump inhibitors used during this time. A new tube was successfully replaced. This case highlights an important learning point: delayed replacement can be a viable strategy in avoiding surgery in buried bumper syndrome when endoscopic placement is not otherwise feasible.