Intracranial Insertion of a Nasogastric Tube in a Case of Homicidal Head Trauma

Abstract

A case of accidental intracranial penetration of a 29-cm-long portion of nasogastric tube (NGT) in a 27-year-old female victim of a severe homicidal skull and brain trauma is reported. Accidental penetration of the NGT occurred through a large fracture of the ethmoid lamina cribrosa. In addition to a systematic review of previously reported cases, circumstantial data, clinical aspects, and autopsy data have been analyzed to draw medicolegal considerations concerning the connection between death and insertion of an NGT, which may also contribute to the ascertaining of any possible professional responsibility of medical staff, in a case fraught with numerous legal complications.

Inadvertent insertion of a nasogastric tube in a patient with head trauma

“…Moustoukas described two aetiological factors as possible causes of intracranial displacement of a nasogastric tube: a basilar fracture extending through the cribriform plate, and thin cribriform plate perforation by a rigid tube [19]. As in our case, the cribriform plate was the insertion site of the nasogastric tube in 18 of the 26 cases in the literature [1,2,4,6,7,8,9,10,12,14,18,19,20,21,22,23]. The most frequently encountered site for misdirection of a nasogastric tube into the cranium is the cribriform plate in patients with craniofacial trauma [1,2,4,6,7,10,12,14,18,19,20,22].…”

“…However, intracranial displacement of nasogastric tubes is a rare though serious complication in patients with complex craniofacial trauma [1,2,3,4,6,7,8,10,12,14,15,18,19,20,22]. To the best of our knowledge, 25 cases of such occurrences have been reported in the literature, but the present case is the first in Turkey (Table 1).…”

Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer

“…No adverse event related specifically to tube insertion, such as intracranial insertion 15 , pneumothorax 16 and oesophageal perforation 17 , was reported in any of the studies.…”

Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all?

“…Contrary to popular belief 6,7,41,43,49,71,108,116 nasal intubation has been shown to be safe in the presence of skull-base fractures 4 with no reports of intracranial passage, but it is technically more demanding, increases the rate of bleeding and sinusitis beyond 72 h and requires a patent nasal airway 113 . Awake fibre-optic intubation, although useful in spinal injuries, is not without risks 91 , particularly in an emergency setting where visualisation is usually limited by the presence of blood and oedema, and the airway being partially obstructed 89 .…”