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

Abstract

Misplacement of nasogastric tubes into the pleural space is a rare occurrence, generally associated with transbronchial placement of narrow-bore feeding tubes with metal stylets. L2 We present a case which illustrates the potential for intrapleural placement of a polyvinyl chloride nasogastric tube frllowing traumatic nasotracheal intubation. The case highlights the possibility of oesophageal perforation during both nasogastric and nasotracheal intubation, and the potential for particularly severe injury when complications of both procedures occur in tandem. Since nasogastric intubation often fol-CAN J ANAESTH 1996 / 43:12 /pp1252~fi

Nasoenteric Tube Complications

“…For example, cervical crepitus is seen in ~60% of cervical esophageal perforations, one-third of mid-esophageal perforations, and is uncommon in distal esophageal perforation. While most esophageal perforations are associated with pneumothorax, pneumomediastinum, and pleural effusion(s), as many as 12% have no associated acute radiographic findings (48). Posterior nasopharyngeal perforations may produce left pleural effusion and pneumomediastinum (49).…”

Fatal Hydrothorax Due to Misplacement of a Nasoenteric Feeding Tube

“…9 Due to close proximity of the oesophagus and pleura, perforation of the proximal oesophagus often involves the pleural cavity. 3 In this patient, the presence of tachycardia, fever and cervical tenderness suggested oesophageal perforation. Although we had no FIGURE 1: Chest radiograph, revealing left-sided pleural effusion, of a 67-year-old male intensivecare patient who experienced hydrothorax due to misplacement of a nasoenteric feeding tube before (A) and after (B) aspiration of pleural contents.…”

A case report of esophageal perforation: Complication of nasogastric tube placement

“…On the 5 th day after nasogastric application, 2 patients were diagnosed with left-sided perforations, treated medically, and discharged in Gruen’s study, and 1 patient was diagnosed with a right-sided perforation and died following surgical treatment in Fisman’s study [8,9] (Table 1). Manhal et al described 33 cases of esophageal perforation between 1976 and 1991.…”