RESUMEN
Nasogastric (NG) tube insertion is a routine procedure performed for a variety of indications, such as delivering enteral nutrition. NG tubes can be associated with complications, including knotting of the tube. The case of a 68-year-old who was admitted to the hospital for AIDS complicated by septic shock is presented. The patient received an NG tube to provide enteral nutrition, which was subsequently found to be clogged. An X-ray of the pharynx revealed a knot at the distal end of the NG tube. The knotted NG tube was removed with a fiberoptic bronchoscope through the nostril. The knotting of an NG tube is a rare complication. Clinicians should be aware of alternative methods of removing knotted NG tubes, including the use of a fiberoptic bronchoscope.
RESUMEN
Nasogastric and orogastric tube (NGT/OGT) insertion is a routine in-hospital procedure used in patients who need enteral feeding, medication administration, and gastric decompression in a patient unable to tolerate per oral administration. NGT insertion has a relatively low complication rate when performed adequately; however, previous studies demonstrate that associated complications range from delicate, simple nose bleeds to more severe conditions such as nasal mucosal bleeding, which can be easily aspirated in a patient with encephalopathy or other conditions associated with the inability to protect the airway. Here we present a case of traumatic NGT insertion causing nasal bleeding, leading to respiratory distress secondary to aspiration of blood clot obscuring the airway.
RESUMEN
Although complications of a nasogastric tube (NGT) are identified and managed in daily clinical practice, gastric perforation following NGT insertion is a serious and rarely reported condition in adults. We present a case of a 71-year-old male who was brought to the hospital after having a cardiac arrest. Following stabilisation and receiving an emergency percutaneous coronary intervention (PCI), he was admitted to the intensive care unit (ICU), where he required NGT for feeding purposes. A few days later, abdominal distension was noted, and chest imaging was requested mainly for worsening respiratory parameters. A computed tomography (CT) scan confirmed gastric perforation and a misplaced NGT. Being a high-risk patient and in the absence of peritonism and frank sepsis, conservative management was adopted and included proton pump inhibitors (PPI), total parenteral nutrition (TPN), stomach aspiration via a Ryle tube and consideration of imaging-guided drainage. No risk factor for gastric perforation was identified in this presented case. The stable course of follow-up suggested sealed perforation; however, he died due to an extensive intracardiac thrombus. Though this incidence did not contribute directly to the patient's death, it definitely added to the overall morbidity and negatively influenced the management of the other medical conditions. For complement, we also report a review of the ten similar cases in the literature, highlighting the associated risk factors, relevant clinical challenges, lines of management executed. The main aim of this case report is to enhance doctors' awareness of this serious complication, especially in patients with risk factors, and its diagnostic dilemmas. Early recognition and prompt intervention are recommended for a better outcome.
RESUMEN
Tracheopulmonary complications following placement of a nasogastric (NG) feeding tube are uncommon but can cause significant morbidity and mortality. In this case report, an 83-year-old woman of American Society of Anesthesiologists class IV with underlying pulmonary disease required placement of an NG feeding tube after surgical treatment of primary squamous cell carcinoma of the tongue. Malpositioning of the NG feeding tube into the right pleural space was confirmed by computed tomography. Removal of the NG feeding tube resulted in a tension pneumothorax that necessitated chest tube placement. Because of the difficulty of blind NG feeding tube placement in this patient, the subsequently placed NG feeding tube was successfully positioned with the aid of a video laryngoscope. This case report illustrates the risk of NG feeding tube malpositioning in a nasally intubated patient undergoing head and neck surgery and discusses improvements in techniques for proper NG feeding tube placement.