Successful implantation of a button gastrostomy in >> buried bumper << syndrome

History and clinical findings: A 65-year-old patient had a fracture of the skull with resulting swallowing disorder and underwent percutaneous endosco pic gastrostomy (PEG) 9 months previously. A specific home care and mainten ance of the PEG was not provided. The patient was referred to our hospital because of haematemesis on the suspicion of upper gastrointestinal bleeding . He was in a generally reduced condition with the clinical signs of anaemi a and with a positive shock index. Investigations: The laboratory tests revealed an anaemia. The gastroscopy s howed an active bleeding ulcer under the migrated internal bumper of the PE G (buried bumper syndrome). The bleeding activity was classified as Forrest Ib. In addition, the chest X-ray and the bronchoscopy showed bilateral pne umonia. Diagnosis, treatment and course: Summarizing the diagnoses there was an act ive bleeding ulcer in the sense of a buried bumper syndrome in combination with bilateral pneumonia caused by aspiration. After releasing the bumper t he bleeding was stopped by local injection therapy. As additional treatment of the lesion it was aimed to lower pressure on the affected mucosal area. This was achieved by the use of a button gastrostomy with a liquid-filled retention balloon that was placed through the preexisting stoma. The pneumo nia was treated with antibiotics. Follow-up gastroscopies revealed good hea ling of the ulcer and the patient was discharged. Conclusions: The complication of a buried bumper syndrome with ulcer bleedi ng can effectively be treated by the use of a button gastrostomy. Treatment is based on sufficient pressure relief in the affected mucosa area. Advant ages can be seen in the maintenance of the stoma and in the opportunity for an early continuation of enteral feeding.