What is the usual clinical presentation for buried bumper syndrome?

• A. Excessive pain at the PEG site, excessive tightening of the external bolster may lead to ischemic necrosis of the gastric wall and migration of the internal bolster either into the gastric wall, abdominal wall, or even into subcutaneous tissue and skin
• B. Fever and drainage around the site
• C. Nausea without external signs
• D. Sudden severe bleeding at the stoma

Answer: (A)

Buried bumper syndrome presents when the external bolster is tightened enough to press the internal bumper firmly against the gastric wall, causing ischemia and necrosis of the tissue. That sustained pressure can embed the internal bumper in the gastric wall and even drive it into the gastric wall, abdominal wall, or subcutaneous tissue, which is why severe pain at the PEG site with a tightly tightened external bolster is the hallmark. Fever or drainage around the site can occur if infection develops, but they are not the defining feature of this condition. Nausea without external signs and sudden severe bleeding at the stoma are not typical presentations of buried bumper syndrome.