Perforation during nasogastric and orogastric tube insertion

Intra-abdominal nasogastric tube placement following inadvertent nasopharyngeal perforation

We report the case of a patient who had a nasogastric tube inserted following cardiac surgery that was determined to be appropriately sited on chest X-ray. Following initiation of nasogastric feeding, however, the patient became acutely unwell. Subsequent computed tomography imaging demonstrated that the nasogastric tube had perforated through the posterior nasopharynx and passed through the mediastinum into the abdominal cavity. A laparotomy and washout was required, and following a prolonged intensive care stay with multiple further interventions, the patient ultimately survived to discharge. Pharyngeal wall perforation is a rare but serious complication of attempted nasogastric tube insertion. Risk factors include the need for repeated attempts and patients with an altered mental state. The appropriate steps in confirming the position of nasogastric tubes both clinically and radiologically are reviewed in the context of this rare and serious complication.

A case report of esophageal perforation: Complication of nasogastric tube placement

PATIENT

Male, 70 FINAL DIAGNOSIS: Esophageal perforation Symptoms: Abdominal pain • nausea • vomiting

MEDICATION

- Clinical Procedure: - Specialty: Surgery.

OBJECTIVE

Unusual clinical course.

BACKGROUND

Esophageal perforation is a well-defined and severe clinical condition. There are several etiologies of esophagus perforation.

CASE REPORT

We report the case of a 70-year-old Caucasian man who underwent an emergency cholecystectomy due to acute cholecystitis. Two days after surgery, his condition deteriorated. Thorax computerized tomography revealed an esophageal perforation.

CONCLUSIONS

Esophageal perforation due to nasogastric application is relatively rare but the consequences are potentially serious. The anatomy of the upper gastrointestinal system should be understood by all healthcare professionals involved in the treatment.

Methods and complications of nasoenteral intubation

Nasoenteral intubation is among the most common procedures performed by clinicians across all medical specialties. The most common technique for nasoenteral intubation is blind passage, as it does not require the use of sophisticated or expensive medical equipment. Unfortunately, blind placement too frequently results in trauma and is a source of significant morbidity and mortality. It is apparent that altered mental status, a preexisting endotracheal tube, and critical illness put a patient in a higher risk group for malposition and complications. Nasoenteral intubation should be attempted only with an understanding of the possibility for difficult placement and the potential complications that can arise from trauma or malposition.

A new endoscopic technique for the removal of gastric phytobezoars

BACKGROUND

There is no standardized method for the evacuation of gastric phytobezoars. Prior endoscopic attempts have used injected cellulase and various devices to disrupt bezoars. The efficacy of directed, large-channel suction using an endoscope for the removal of large gastric phytobezoars is the subject of this study.

METHODS

Three consecutive patients with large gastric bezoars were examined. Phytobezoar removal using a standard endoscope (GIF-100, Olympus) was attempted but unsuccessful. Each phytobezoar was successfully evacuated by directed suction through an endoscope with a large-diameter accessory channel (GIF-XT30, Olympus). Each patient was followed up for bezoar recurrence.

RESULTS

Rapid, complete bezoar evacuation was achieved at one session in all patients. Aspirated volumes were 500, 700, and 1000 mL. There were no procedure-related complications.

CONCLUSIONS

Endoscopic suction removal of gastric phytobezoars using a large-channel endoscope is efficacious and safe. Coupling directed endoscopic suction with other endoscopic techniques might be efficacious for removal of more complex bezoars.