Pneumothorax occurring after nasogastric tube removal

Abstract

An 85-year-old woman with failure to thrive due to poor oral intake was admitted owing to dehydration. A nasogastric (NG) tube was inserted for the initiation of enteral feedings. The tube position was confirmed by gastric auscultation after insufflating air through the tube. A chest X-ray revealed that the NG tube traversed the right main stem bronchus with its tip ending in the right costophrenic angle adjacent to the pleura. No pneumothorax was identified. The tube was removed and a short while later the patient developed mild chest discomfort. A repeat chest X-ray revealed significant pneumothorax on the right side. She was treated conservatively with 100% oxygen with successful resolution of the pneumothorax.

A simple procedure gone wrong: pneumothorax after inadvertent transbronchial nasogastric tube insertion necessitating operative management.

“…In the majority of case reports, NGT associated pneumothoraces were seen on the same initial radiograph demonstrating the malpositioned NGT. Our patient’s case on the other hand is similar to the case published previously as the first known case of pneumothorax post NGT removal in BMJ Case series in 2013 [5]. Like in the previous case report, the pneumothorax in our patient was only present after the malpositioned NGT was removed.…”

“…Of note, transbronchial nasogastric tube insertion is potentially hazardous if feeding is commenced. Reported factors associated with pulmonary complications of feeding tube placement include altered mental status, smaller bore tubes and endotracheal intubation or tracheostomy [5].…”

Hemothorax Following Traumatic Dobhoff Tube Insertion

“…Prior reports of traumatic Dobhoff placement have described situations in which attempts at insertion were met with some resistance [ 7 ]. Others described uneventful placements with no resistance or other hints that misplacement had occurred [ 4 , 10 ]. Because the inciting event in the current case occurred at a hospital outside of the authors’ institution, the full context surrounding the feeding tube misplacement is unclear.…”

“…A large majority of these cases are met with no complications. However, there have been several reported instances of inadvertent bronchopulmonary placement that have resulted in significant pulmonary trauma, particularly pneumothorax [3][4][5][6][7][8]. Hemothorax (a collection of blood within the pleural cavity) has been mentioned as a potential complication of a misplaced enteral feeding tube, but very few cases have been documented previously [9,10].…”

Forensic Considerations of Spontaneous Pneumothorax in Sudden Unexpected Natural Death

“…While iatrogenic pneumothoraces are technically traumatic and not spontaneous in etiology, the forensic pathologist and medicolegal death investigator must be vigilant in reviewing medical histories for recent medical procedures in patients with respiratory distress and chest pain prior to death, as a source of iatrogenic trauma may not be readily apparent and pneumothorax symptoms may be delayed. In addition to being a well-known complication of subclavian central venous catheterization, pneumothoraces have also been documented following transthoracic and transbronchial needle biopsies (66), mechanical ventilation, nasogastric tube placement (67), tracheostomy (68), endoscopic retrograde cholangiopancreatography (69), and supraclavicular brachial plexus block (70), among other procedures. Pneumothoraces have also been documented following acupuncture of the chest wall (71, 72), with rare reported fatalities (73).…”