A Variant Form of Nasogastric Tube Syndrome

Abstract

Nasogastric tube syndrome named by Sofferman et al in 1981 is a laryngeal complication presenting with lifethreatening vocal cord abductor paralysis derived from peroforation of the NG tube-induced esophageal ulcer. As compared with the previously reported cases of this syndrome, our 4 autopsied patients were so peculiar in the following two points that vocal cord abductor paralysis developed repeatedly and no esophageal ulcer was present in spite of the presence of the laryngeal abductor muscle injury. We hypothesized that the etiology of such a variant form was circulatory injury of the laryngeal abductor muscle which was caused by the compression of the postcricoid blood vessels perfusing this muscle. Nasogastric tube syndrome, which is treatable by decannulation, cannot be ruled out even if no esophageal ulcer is detected by fiberoptic laryngoscopy.

Nasogastric tube syndrome induced by an indwelling long intestinal tube

“…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] .…”

Severe Vocal Cord Dysfunction: An Unusual Complication of Juvenile Dermatomyositis

“…In nasogastric tube syndrome, the midline nasogastric tube may cause post-cricoid inflammation/ulceration and neuropraxia of the posterior division of recurrent laryngeal nerve, and subsequent vocal cord abduction paralysis 5,6,7 . Patients with this syndrome typically develop throat pain, stridor, and upper airway obstruction, and our patient had none of these features.…”

Impact of fiber-optic laryngoscopy on the weaning process from mechanical ventilation in high-risk patients for postextubation stridor

“…By exerting a prolonged extrinsic compression on the posterior cricoarytenoid muscle, the nasogastric tube can rarely cause ulceration and ischemia of this muscular structure resulting in a dramatic paralysis of the vocal folds in adduction. [ 18 ] Finally, severe gastro-esophageal reflux (GER) is a classic provider of voluminous edema of the arytenoids and hypertrophy of the posterior commissure. [ 19 ] Many conditions that promote GER—such as recumbent position, obesity, high intra-abdominal pressure, delayed gastric emptying, recent abdominal surgery, drug-induced nausea, for instance—are very common in the ICU and explain why critically ill patients are particularly at high risk of developing GER.…”