A case of intramural oesophageal dissection secondary to nasogastric tube insertion

Abstract

ABSRACTIntramural oesophageal dissection is a rare disorder, caused by the interposition of a divisive force between the mucosal and muscular layers of the oesophagus, leading to their separation. We present a case of intramural oesophageal dissection, secondary to the accidental iatrogenic intramural insertion of a nasogastric tube. We discuss the aetiologies, presentation, investigation and treatment of intramural oesophageal dissection, and make recommendations on the management of suspected oesophageal perforation with prophylactic nasogastric tube insertion. We also discuss other complications associated with nasogastric tube insertion, and how these may be avoided.

Intramural dissection with mucosal rupture alleviating phlegmonous esophagitis

“…For those with concomitant esophageal involvement, especially esophageal mucosal injury, an alternative solution with feeding gastrostomy or jejunostomy should be executed to avoid devastating complications due to possible esophageal perforation [6]. Though a simple procedure, NG-tube insertion itself may cause undesirable complications, such as upper aerodigestive tract injury or esophageal perforation [2]. Esophageal intramural dissection, which is extremely rare, has seldom been reported with NG-tube insertion [2].…”

“…Though a simple procedure, NG-tube insertion itself may cause undesirable complications, such as upper aerodigestive tract injury or esophageal perforation [2]. Esophageal intramural dissection, which is extremely rare, has seldom been reported with NG-tube insertion [2]. To the best of our knowledge, the concurrent presence of acute phlegmonous esophagitis and esophageal intramural dissection has never been described in the literature.…”

“…The occurrence of 'esophageal' intramural dissection is usually due to iatrogenic causes, such as nasogastric (NG)-tube insertion or endoscopy [1,2]. An underlying etiology or abnormal anatomy, such as inflammation, intramural hematoma, stricture, or diverticula may complicate NG-tube insertion and predispose to this intractable condition [2].…”

“…An underlying etiology or abnormal anatomy, such as inflammation, intramural hematoma, stricture, or diverticula may complicate NG-tube insertion and predispose to this intractable condition [2]. However, acute phlegmonous esophagitis, a rare esophageal pathology, has never been reported to be associated with intramural dissection [3,4].…”

Iatrogenic Esophageal Perforation: An Occurrence from Feeding Tube Placement in a Premature Infant with a Pneumothorax

“…In newborns, particularly premature infants, an esopha geal perforation (EP) occurs when inserting a feeding tube, probably more frequently than reported in the literature 13) .…”