2011 Volume 18 Issue 3 Pages 401-404
Some reports have been published of fatal complications associated with insertion of a nasogastric tube. The study presented here deals with on our experience with a patient in whom insertion of a nasogastric tube led to esophageal perforation. An 87-year-old female was hospitalized, presenting with hematemesis. Emergency endoscopy showed an esophageal hiatal hernia and lower esophageal erosion, which were identified as the sources of the bleeding. On day 4 of hospitalization, it was found that the patient was having difficulty ingesting food orally. A nasogastric tube was therefore inserted, and its intragastric placement was confirmed by means of chest X-ray and gastric bubble auscultation. However, because of stomach pain 10 hours after the start of continuous tubal feeding, enteral feeding was halted immediately. We subsequently confirmed that the patient had developed a fever and an elevated inflammatory response. Since findings on a chest-abdominal CT led us to suspect the feeding tube had caused esophageal perforation, so we performed emergency surgery. The feeding tube was found to have strayed, penetrating from the posterior esophageal wall into the retroperitoneal space. The patient's postoperative course was good. Although insertion of a feeding tube is a comparatively simple procedure, there is no guarantee that the tube is placed in correct position even if its position is confirmed by standard means of chest X-ray and gastric bubble auscultation. Our experience indicates that reliable method for confirming the position of the tube is necessary.
