Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review
Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the r...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2023/4230158 |
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| author | Mohammad Alabdallat Gustav Strandvik Ibrahim Afifi Ruben Peralta Ashok Parchani Ayman El-Menyar Sandro Rizoli Hassan Al-Thani |
| author_facet | Mohammad Alabdallat Gustav Strandvik Ibrahim Afifi Ruben Peralta Ashok Parchani Ayman El-Menyar Sandro Rizoli Hassan Al-Thani |
| author_sort | Mohammad Alabdallat |
| collection | DOAJ |
| description | Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated—and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event. |
| format | Article |
| id | doaj-art-a450abfc8e2049099de741bdb39a0b36 |
| institution | Kabale University |
| issn | 2090-6919 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-a450abfc8e2049099de741bdb39a0b362025-02-03T06:42:40ZengWileyCase Reports in Surgery2090-69192023-01-01202310.1155/2023/4230158Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature ReviewMohammad Alabdallat0Gustav Strandvik1Ibrahim Afifi2Ruben Peralta3Ashok Parchani4Ayman El-Menyar5Sandro Rizoli6Hassan Al-Thani7Department of SurgeryDepartment of SurgeryDepartment of SurgeryDepartment of SurgeryDepartment of SurgeryDepartment of SurgeryDepartment of SurgeryDepartment of SurgeryBackground. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated—and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.http://dx.doi.org/10.1155/2023/4230158 |
| spellingShingle | Mohammad Alabdallat Gustav Strandvik Ibrahim Afifi Ruben Peralta Ashok Parchani Ayman El-Menyar Sandro Rizoli Hassan Al-Thani Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review Case Reports in Surgery |
| title | Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review |
| title_full | Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review |
| title_fullStr | Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review |
| title_full_unstemmed | Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review |
| title_short | Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review |
| title_sort | occult perforation of the esophagus during removal of an enteral feeding tube a case report and literature review |
| url | http://dx.doi.org/10.1155/2023/4230158 |
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