A rare complication with feeding tube insertion: a case of intramural esophageal dissection

Abstract

We report a case of intramural esophageal dissection caused by the feeding tube, which is a rare complication of feeding tube insertion. A 19-year-old woman was transferred to our hospital in cardiopulmonary arrest following a traffic accident. After spontaneous circulation returned, she was admitted to the ICU in a comatose condition. A feeding tube was inserted orally, and the tube location was confirmed via X-rays and the auscultatory method. On the fourth hospital day, pneumomediastinum appeared on chest X-ray. Upper gastrointestinal endoscopy revealed that the feeding tube had caused intramural esophageal dissection, descending within the esophageal wall and then returning back into the stomach at the gastric cardia. The feeding tube was immediately removed, at which point the intramural esophageal dissection spontaneously resolved. Intramural esophageal dissection may be difficult to detect via standard methods when the tip of the feeding tube returns inside the gastrointestinal tract. Patients with feeding tubes should undergo careful observation even after enteral nutrition is started.