Oesophageal obstruction during nasogastric feeding

Although complications of enteral feeding are usually minor, we report an unusual and serious case of oesophageal obstruction after feeding with osmolite, a commonly used polymeric enteral feeding preparation. The patient described underwent rigid oesophagoscopy to remove the feed which had solidified and blocked the entire oesophageal lumen. The procedure resulted in oesophageal perforation which needed surgical repair by thoracolaparotomy and was followed by a difficult postoperative course. In vitro tests showed that all commonly used feeds containing casein (osmolite, ensure, ensure plus, paediasure, fortison, and pulmocare) solidified at a pH of less than 5. Clinifeed (containing dried skim milk) and peptamen (containing peptides) remained liquid at a pH of less than 1. Solidified feed could be liquefied by the addition of pepsin or pancrex V (a pancreatic enzyme formulation). We conclude that solidification could occur in all feeds containing casein and that alternative feeds should be considered in patients with increased gastric acidity. In addition, pepsin or pancrex V could be used to liquefy solidified feed.