2016 Volume 67 Issue 4 Pages 289-294
The nasogastric tube (N-G tube) has become frequently used in routine medical care. Although complications caused by N-G tube insertion are rare, nasogastric tube syndrome (NGTS) causes severe complications such as bilateral vocal cord paralysis and supraglottic edema. We reported 2 cases of patients with abrupt onset of serious airway obstruction presumed to be due to NGTS, together with bibliographic considerations. Case 1 was an 83-year-old male who presented with dyspnea and stridor during medical treatment for ileus at his previous doctor. He showed adduction paralysis of the bilateral vocal cords, and we performed an emergency tracheotomy. Case 2 was a 51-year-old woman suffering from progressive stomach cancer. She presented with pyloric stenosis, and an N-G tube was inserted. After 3 days, she showed dyspnea and stridor as well as adduction paralysis of the bilateral vocal cords. We performed a tracheotomy. NGTS is a syndrome that causes sore throat, bilateral vocal cord paralysis and supraglottic edema. Infection in the posterior cricoid region caused by ulcerative lesions at the upper end of the esophagus has been implicated as a pathophysiological mechanism of this syndrome. The albumin level was very low in both of our cases, implying a severely malnourished or immunocompromised state, which may represent a high risk factor for this syndrome. After N-G tube insertion, observation of the larynx using fiberscopy is recommended especially for patients suffering from malnutrition. Whenever this life-threatening syndrome is suspected, direct vocal cord examination and removal of the tube are recommended.
