Intrapleural placement of a nasogastric tube: an unusual complication of nasotracheal intubation

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
D N Fisman, M E Ward

Abstract

Although rare, the misplacement of nasogastric tubes into the pleural space has been described. The prognosis of such injuries is improved by prompt recognition; therefore, it is important for physicians who practice nasogastric intubation to be aware of this potential complication, and to be familiar with an approach to early diagnosis. We present a case of perforation of the cervical oesophagus by a polyvinylchloride nasogastric tube, following a traumatic attempt at nasotracheal intubation. This resulted in passage of the nasogastric tube into the pleural space. Our experience with this case and a review of the relevant literature suggest that such trauma may predispose to malplacement of nasogastric tubes. Clinical signs, such as aspiration of fluid from a nasogastric tube, and auscultation of air insufflated into the stomach, are unreliable; however, the presence of subcutaneous air in the neck on chest radiograph, and the presence of cervical crepitance on physical examination, are valuable signs in the early diagnosis of perforation of the cervical oesophagus. Contrast oesophagography remains the diagnostic manoeuvre of choice in confirming the diagnosis, but early diagnosis will depend on a high index of suspicion and p...Continue Reading

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Citations

May 14, 1998·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·E CarrilloJ A Tortosa
Oct 27, 2012·The Journal of Laryngology and Otology·V SankarK W Ah-See
May 8, 2014·The American Journal of Case Reports·Arda IsikMehmet Soytürk
Sep 1, 2014·Radiologic Clinics of North America·David M ValenzuelaBenjamin M Yeh
Apr 21, 2006·Seminars in Ultrasound, CT, and MR·Mihra S TaljanovicMichael J O'Brien
Jan 28, 2006·Journal of the Formosan Medical Association = Taiwan Yi Zhi·Pei-Yu WuWei-Hung Chan
Dec 1, 2001·The Journal of International Medical Research·B YavaşcaoğluO Kutlay
Sep 13, 2012·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·S PrabhakaranS P A Stawicki
Oct 28, 2010·JPEN. Journal of Parenteral and Enteral Nutrition·Owen HalloranAshish Sinha
Dec 22, 1999·Anesthesiology·K B DominoF W Cheney

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