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Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper.
Gastroenterol Nurs. 2009 Jul-Aug; 32(4):259-63.GN

Abstract

Two complications are reported from excessively taut application of percutaneous endoscopic gastrostomy (PEG) external bumpers against the abdominal wall skin. First, a 55-year-old woman status post PEG developed a gastric ulcer, complicated by acute gastric bleeding, directly underneath the internal gastric PEG bumper. This complication was associated with replacement by an unknown healthcare worker of the standard flexible external (cutaneous) PEG bumper with an unauthorized rigid external clamp (bumper) and with excessively taut application of this clamp against the abdominal wall skin. No other causes or risk factors for gastric ulcers were present. The pathophysiology of this ulcer, similar to that of a decubitus ulcer, appears to be mucosal ischemia and pressure necrosis. Second, a 37-year-old man status post PEG developed a buried internal gastric bumper that caused PEG malfunction and abdominal pain from excessively taut application of the external PEG bumper. These case reports should alert healthcare workers that replacing a flexible external bumper with a rigid one and that tightening the external bumper excessively may cause pressure necrosis manifesting either as gastric or cutaneous ulcers or as a buried internal bumper. This alert is particularly important for nurses as they are likely to be the first healthcare workers to notice or be told of PEG failure because of their close involvement in the day-to-day care of the patient and their typically close rapport with the patient's family.

Authors+Show Affiliations

Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19696602

Citation

Cappell, Mitchell S., et al. "Two Case Reports of Gastric Ulcer From Pressure Necrosis Related to a Rigid and Taut Percutaneous Endoscopic Gastrostomy Bumper." Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates, vol. 32, no. 4, 2009, pp. 259-63.
Cappell MS, Inglis B, Levy A. Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper. Gastroenterol Nurs. 2009;32(4):259-63.
Cappell, M. S., Inglis, B., & Levy, A. (2009). Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper. Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates, 32(4), 259-63. https://doi.org/10.1097/SGA.0b013e3181b0a1af
Cappell MS, Inglis B, Levy A. Two Case Reports of Gastric Ulcer From Pressure Necrosis Related to a Rigid and Taut Percutaneous Endoscopic Gastrostomy Bumper. Gastroenterol Nurs. 2009 Jul-Aug;32(4):259-63. PubMed PMID: 19696602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper. AU - Cappell,Mitchell S, AU - Inglis,Brett, AU - Levy,Adam, PY - 2009/8/22/entrez PY - 2009/8/22/pubmed PY - 2009/12/16/medline SP - 259 EP - 63 JF - Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates JO - Gastroenterol Nurs VL - 32 IS - 4 N2 - Two complications are reported from excessively taut application of percutaneous endoscopic gastrostomy (PEG) external bumpers against the abdominal wall skin. First, a 55-year-old woman status post PEG developed a gastric ulcer, complicated by acute gastric bleeding, directly underneath the internal gastric PEG bumper. This complication was associated with replacement by an unknown healthcare worker of the standard flexible external (cutaneous) PEG bumper with an unauthorized rigid external clamp (bumper) and with excessively taut application of this clamp against the abdominal wall skin. No other causes or risk factors for gastric ulcers were present. The pathophysiology of this ulcer, similar to that of a decubitus ulcer, appears to be mucosal ischemia and pressure necrosis. Second, a 37-year-old man status post PEG developed a buried internal gastric bumper that caused PEG malfunction and abdominal pain from excessively taut application of the external PEG bumper. These case reports should alert healthcare workers that replacing a flexible external bumper with a rigid one and that tightening the external bumper excessively may cause pressure necrosis manifesting either as gastric or cutaneous ulcers or as a buried internal bumper. This alert is particularly important for nurses as they are likely to be the first healthcare workers to notice or be told of PEG failure because of their close involvement in the day-to-day care of the patient and their typically close rapport with the patient's family. SN - 1538-9766 UR - https://www.unboundmedicine.com/medline/citation/19696602/Two_case_reports_of_gastric_ulcer_from_pressure_necrosis_related_to_a_rigid_and_taut_percutaneous_endoscopic_gastrostomy_bumper_ L2 - https://doi.org/10.1097/SGA.0b013e3181b0a1af DB - PRIME DP - Unbound Medicine ER -