Nasogastric tube syndrome: a life-threatening laryngeal obstruction in a 72-year-old patient*

Abstract

Nasogastric tube (NGT) syndrome is a rarely reported complication of NGT use that can cause life-threatening laryngeal obstruction. The syndrome results from post-cricoid ulceration, which affects the posterior cricoarytenoid muscles, thus causing vocal cord abduction paralysis and upper airway obstruction. We describe a case of a 72-year-old patient with this syndrome who was treated successfully and emphasise the difficulty of diagnosis in frail older adults.

Nasogastric tube syndrome induced by an indwelling long intestinal tube

“…Brousseau et al [8] also estimated a range of NTS onset from 12 h after intubation to 2 wk after extubation. Time to recovery from respiratory symptoms and vocal cords dysfunction has been reported at 1 d to 3 mo [3][4][5][6]9,10,12,13] . In our case, the symptoms were present 6 d after long intestinal intubation, and a month was required for complete recovery.…”

“…The mechanisms of NTS can be explained in three parts [3,8,9,12] . First, the mobile laryngeal structures rub against the fixed NGT.…”

“…45, female NGT Removal of NGT, tracheotomy Full recover Apostolakis et al [4] 2001 77, male NGT Removal of NGT, tracheotomy Not recover Apostolakis et al [4] 2001 73, male NGT Removal of NGT, tracheotomy Full recover Leclerc et al [14] 2002 71, female NGT Tracheotomy Not recover (cricoid necrosis) Nehru et al [5] 2003 60, male NGT Removal of NGT, tracheotomy Full recover Sanaka et al [6] 2004 85, male Long intestinal tube Removal of long intestinal tube, tracheotomy Full recover Isozaki et al [7] 2005 73, male NGT None Death Isozaki et al [7] 2005 77, female NGT Removal of NGT Death Isozaki et al [7] 2005 79, female NGT Undescribed Undescribed Isozaki et al [7] 2005 72, female NGT Undescribed Undescribed Marcus et al [9] 2006 72, male NGT Removal of NGT, tracheotomy Full recover Vielva del Campo et al [12] 2010 70, female NGT Removal of NGT, tracheotomy Full recover Ohshima et al [11] 2010 62, female NGT Removal of NGT Full recover Harmon et al [13] 2014 2 mo, male NGT Removal of NGT Full recover Harmon et al [13] 2014 3 mo, female NGT Removal of NGT Full recover Harmon et al [13] should be chosen to reduce the pressure with which the tube presses against the organization. Friedman et al [15] reported that midline tube placement generated severe inflammation in the post-cricoid region more often than lateral tube placement.…”

“…To our knowledge, in all of the medical literature, a total of 20 case reports (Table 1) and 2 reviews (including the case report described) of NTS have been published through 2014 [3][4][5][6][7][8][9][10][11][12][13][14] . Of these cases, only one case was induced by indwelling a long intestinal tube [6] .…”

NG tube syndrome: a case report of a rare complication of NG tube

“…The most crucial step in management is diagnosing the entity. When suspected patient should undergo fiber optic laryngoscopy [5]. This often reveals bilateral vocal cord paresis with post cricoid ulceration.…”