Nasogastric Tube Feeding-Induced Esophageal Bezoar: Case Description

Abstract

Background. Bezoars are well established entities causing gastrointestinal obstructions. Depending on the prominent constituent of these bezoars, the latter are divided into four subtypes: pharmacobezoars, lactobezoars, trichobezoars, and phytobezoars. Less frequently reported types of bezoars are reported including those formed secondary to nasogastric tube feeding with casein-based formulas. Case Presentation. A 69-year-old male presented following cardiac arrest postmyocardial infarction. Patient sustained anoxic brain injury after resuscitation, rendering him ventilator dependant along with nasogastric tube feeding, initially. Dislodging of the nasogastric tube at one time rendered it difficult to reinsert it, with investigation showing the presence of calcified material within the distal oesophagus, mainly composed of casein-based products secondary to enteral feeding. Conclusion. Bezoars are well known to cause gastrointestinal obstructions due to their indigestible characteristics within the alimentary tract. More rare causes of bezoars include those formed from casein-based feeding formulas administered to patients with sustained enteral feeding. Esophageal obstruction, secondary to casein-based bezoars, occurs due to multiple risk factors, especially in those necessitating intensive care. Approach in such scenarios requires a multiteam approach.

Nasogastric/nasoenteric tube-related adverse events: an integrative review

“…In the case presented in this integrative review, bezoar was formed by the enteral formulas that accumulated along the tube. Obstruction prevention requires safe practices in the handling of feeding tubes, which include checking the compatibility of the grinding and medication administration, crushing oral formulas until a fine powder, ensure feed is stopped prior to medication administration, administering medicines separately and washing the tube between administrations (97)(98) .…”

Esophageal Obstruction Caused by the Solidification of Residue of an Enteral Feeding Formula

“…[2][3][4] For example, Tawfic tering acid-lowering medications. Gupta et al 6 recommended administering pancreatic enzyme extract because it can prevent and liquefy the solidification of casein-containing formula.…”

Enteral nutrition-related small bowel bezoar: a case report and literature review

“…The use of pancreatic enzymes for the dissolution of the bezoar was also described [ 4 , 5 ]. In another case, a 69-year-old woman was under mechanical ventilation after cardiac arrest, receiving enteral nutrition by nasogastric tube; after misplacement of the tube, the reinsertion was difficult [ 6 ]. An endoscopy was performed, and an oesophageal bezoar was diagnosed.…”

“…An endoscopy was performed, and an oesophageal bezoar was diagnosed. Due to the terminal condition of the patient, it was not removed and a jejunostomy was performed [ 6 ]. Also, the case of a 74-year-old with myocardial infarction and chronic obstructive pulmonary disease with long hospital stay was reported, in whom, after tube misplacement, reinsertion was difficult.…”