内視鏡的胃瘻造設術後比較的早期に発生したburied bumper syndromeの1例

概要

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We describe an 81-year-old female, who suffered dysphagia attributable to cerebral infarction. In order to provide her long-term nutritional support, we performed percutaneous endoscopic gastrostomy (PEG) . She developed ileus on the following day, and a wound infection 6 days after the tube placement. These complications were treated successfully. On 15th day a part of the bumper of the PEG catheter was seen at the stoma. On the following day, the patient underwent a gastric endoscopic examination, which revealed that the top of the gastrostomy tube was buried beneath the gastric mucosa. The PEG catheter was removed, followed by decompression of the gastric cavity, and disinfection of the wound by the emergency gastroendoscopy, resulting in amelioration of her general condition. In Japan, the incidence of buried bumper syndrome is reported to be 0.4-6.3%, 1.2% on average. So it is a rare complication. Its primary cause is considered to be excessive compression toward the stomach wall. It is, however, very rare to see it shortly after that kind of operation. The main causes of this complication in this case, seemed to be long term and excessive traction of the catheter to prevent outflow of the intestinal contents into the peritoneal cavity in case of ileus, as well as fragility of the abdominal wall due to fistula infection.
Japan Gastroenterological Endoscopy Society Kanto Chapterの論文