Management of BBS

1
Management of BBS
PPI t.i.d.
Divert EN - Convert to PEGJ
Block Acid Production
Position New Bolster
Secure with Hollister Clamp
2
Leakage and Peritonitis
3
Concern for Leakage and Peritonitis
Surgical Perspective
4
Correct Tension of PEG External Bolster
Communication with Endoscopist
8
6
External bolster

• Chung Study
• Tract Complicat
• Tight 4.9cm 13/48
• Loose 11.6cm 1/67
• Conclusion
• Firm for first 3-4 days
• Loose (1cm) thereafter

(gauze)
4
Abdominal wall
2
Gastric wall
Amer Surg 199056134
5
Excess Drainage Mass, Abscess, Breakdown
Passage of PEG Tube through Liver
6
Breakdown / NodularityMetastatic Seeding

• Rare, but 30 cases reported
• Aver time to dx 7.3-8.0 mos
• Sx Drainage Fungating mass
• Bleeding Superinfection
• May require local XRT vs surg

Pickhardt (AJR 2002179735) Brown (Am J Gasro 20
00953288)
7
Stool Around PEG Site Gastrocolocutaneous Fistula
I could swear that smells like

• Acute Peritonitis, infection, fasciitis,
  obstruction
  
• Chronic Stool at site, insidious diarrhea, at
  tube removal

8
Stool Around PEG Site Gastrocolocutaneous Fistula
Mechanism
Inadvertant Puncture versus Delayed Erosion
9
Looking Out for Our Patients

• Nutrition Support Specialist Proactive in
  longterm surveillance
  
• Routine monitoring Reduce risk factors, early
  identification
  
• Simple techniques, good communication provide
  prompt correction