[Lung perforation by a small-bore enteral feeding tube]

A 68 year old male with multisystemic disease, mainly lungs and heart, was treated with a cuffed endotracheal tube, mechanical ventilation and a 16 Fr Levin nasogastric tube for feeding; it was substituted 13 days later by a 2.3 mm, 8 Fr O'Brien KMI polyurethane small bore enteral feeding tube introduced with a guide wire. The feeding tube perforated his right lung and passed into the pleural cavity, either through the larynx or through a nonconfirmed tracheoesophageal fistula; signs for the supposedly correct position of the tube were positive. In patients with depressed sensoria, abnormalities of gag or cough reflexes, esophageal strictures, significant cardiomegaly or tracheoesophageal fistula, small bore enteral feeding tubes should be passed under direct vision by laryngoscopy or preferably by flexible endoscopy; adequate confirmation of the correct position requires a chest and an upper abdominal roentgenogram.