Buried bumper syndrome - gastrostomy tube

Case contributed by Dr Michael P Hartung

Presentation

Gastrostomy tube dysfunction

Patient Data

Age: 65 years
Gender: Male
Fluoroscopy

Presentation

Gastrostomy tube check under fluoroscopy. This was misinterpreted as normal.

AP following injection: opacification of stomach and duodenum. Gastrostomy tube bumper positioned lower than expected, caudal to greater curvature. 

Lateral view: thin channel from body wall opacifying stomach, indicated malpositioned bumper with injection traveling through a thin tract into the stomach. 

CT

Presentation

G-tube bumper buried in anterior abdominal wall, just superficial to the rectus abdominis. 

Small amount of fluid near end of tube/bumper. Channel of scar tissue extending to gastric antrum, which is scarred to abdominal wall. 

X-ray

After attempted blind G-tube replacement in ED

After attempted replacement of the gastrostomy tube, there is extraluminal positioning of the G-tube balloon below the stomach and above the transverse colon. Free intraperitoneal spillage of contrast. 

CT

After attempted blind G-tube replacement in ED

Attempt at tube replacement at bedside in ED. 

Tube is now inferiorly positioned and intraperitoneal outside of the tract, with free spillage of contrast. 

Case Discussion

Great case showing manifestations of buried bumper on fluoroscopy and CT. Notice how fluoroscopic images can be fairly subtle, particularly AP, and require lateral view to really show buried positioning of the bumper - it can otherwise overlap with stomach on AP.

Failed bedside replacement of tube shows value of using fluoroscopic guidance. 

Tube was replaced surgically following failed attempt. 

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Case information

rID: 63843
Published: 20th Oct 2018
Last edited: 22nd Oct 2018
Inclusion in quiz mode: Included

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