2024 Volume 37 Issue 1 Pages 81-88
Introduction: Nasogastric tubes are inserted for the purpose of enteral nutrition, gastric decompression, gastric lavage, drug administration, and specimen collection. The most common site of nasogastric tube insertion is into the trachea, but lung injury, pneumothorax, perforation of the gastrointestinal tract, and intracranial insertion have been reported. Here, we report a case of airway stenosis and cervical subcutaneous emphysema caused by pharyngolaryngeal swelling and hematoma after insertion of a nasogastric tube, which resulted in emergency surgery.
The patient was a 75-year-old male with the chief complaint of dyspnea, and a history of dementia and cerebral infarction. The patient was referred to our internal medicine department for a thorough examination of pleural effusion. After returning home, he developed pharyngeal pain and fever, right cervical swelling, epistaxis, and respiratory distress, and was brought to the emergency department of our hospital. He was referred to our department on suspicion of a cervical abscess. A submucosal hematoma and swelling were observed in the pharyngeal region, and the patient had airway stenosis. A contrast-enhanced CT scan of the cervical region showed an image of gas in the cervical region, suggesting infection with gas-producing bacteria, and so an incisional drainage procedure was performed on the same day. The patient’s general condition improved postoperatively, and he was discharged from the hospital.
Conclusion: The patient had a tendency to hemorrhage due to anticoagulant medication, and it was considered that submucosal hemorrhage and emphysema had spread extensively from the nasopharynx to the neck and caused airway narrowing due to mucosal damage of the nasopharyngeal cavity caused by the nasogastric tube.
