Delayed gastric perforation following nasogastric tube insertion: the pitfalls of radiographic confirmation

Abstract

A man in his 70s, admitted to intensive care unit following an out of hospital cardiac arrest, had a nasogastric (NG) tube inserted on admission. Correct placement of the NG tube had been confirmed using National Patient Safety Agency (NPSA) criteria and was used for feeding without incident. He remained intubated and ventilated throughout his stay. On day 9 his oxygen requirements increased with subsequent chest imaging revealing an incidental gastric perforation secondary to NG tube migration. The NG tube was removed intact and undamaged. The patient appeared to improve without sequelae from the perforation or signs of abdominal sepsis. Unfortunately his condition deteriorated due to a large right atrial thrombus and life sustaining treatments were withdrawn.

Delayed Gastric Perforation by Nasogastric Tube: A Case Report

“…4 There are only two previous case reports and a case series of delayed gastric perforation by NG tube reported in English literature. 5,6,9 A case series reported in 1980 had only two cases of delayed gastric perforation by NG tube with limited clinical information. 9 We were not able to identify risk factors by any statistical analysis, but a commonality was impressive: all three patients of the three case reports including our current case report underwent ICU care for cardiogenic shock with radiographic evidence of the NG tube's tip located at the gastric fundus, and their NG tubes were maintained more than 5 days until gastric perforation occurs (Table 1).…”

“…[2][3][4] Delayed gastric perforation by NG tube is even rarer. 5,6 We report a rare case of a delayed gastric perforation by the NG tube in an adult patient with end-stage heart failure.…”