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Radiographic confirmation of feeding tube placement: a diagnostic tool identifying gastrointestinal anomalies
Hanifi Soylu1, Nathan E Wiseman, Yasser El-Sayed
1Division of Neonatology, WS-012 Women’s Hospital, Winnipeg, MB, Canada. hasoylu@hotmail.com
Insights
Abnormally placed feeding tubes in newborns can signal serious issues. Radiographic findings of misplaced orogastric (OG) tubes aided in diagnosing esophageal perforation and gastric volvulus in two infants.
Area of Science:
- Neonatal Medicine
- Pediatric Radiology
- Gastroenterology
Background:
- Feeding tubes are essential in neonatal intensive care units (NICUs).
- Malpositioned feeding tubes on radiographs can indicate critical underlying conditions.
- Accurate feeding tube placement is crucial for patient safety and effective nutrition.
Observation:
- Two neonates experienced clinical deterioration.
- Abnormal feeding tube positions on radiographs revealed serious underlying conditions.
- Case 1: Right-sided pneumothorax and esophageal perforation due to orogastric (OG) tube displacement.
- Case 2: Recurrent vomiting linked to an OG tube in a cystic mass, indicating a herniated stomach with organoaxial volvulus.
Findings:
- Feeding tube malposition can be an indicator of critical neonatal pathology.
- Iatrogenic esophageal perforation was diagnosed in one case based on tube displacement.
- Gastric herniation and volvulus were identified in the second case due to tube position.
Implications:
- Feeding tube position has significant diagnostic value beyond nutritional support in neonates.
- Prompt recognition of malpositioned tubes can lead to timely diagnosis and intervention for life-threatening conditions.
- This highlights the importance of meticulous radiographic assessment of feeding tubes in critically ill newborns.
Abstract:
Feeding tubes are commonly used in neonatal intensive care units, and their abnormal position seen on radiographs may indicate underlying serious problems. We recently cared for two infants who presented with clinical deterioration. An abnormally placed feeding tube seen on the chest radiograph revealed underlying serious conditions. The first case was an infant 29 weeks of age who presented with right-sided pneumothorax after birth. By history and a right-side-displaced orogastric (OG) tube, iatrogenic esophageal perforation was diagnosed. The second case was a 16-day-old infant who presented with recurrent vomiting. An OG tube extending into a cystic mass at the right cardiophrenic angle resulted in diagnosis of a herniated stomach with organoaxial-type volvulus, which required surgical repair. Both cases recovered uneventfully. As illustrated in these two rare cases, feeding tube position is not only important for feeding practice, but it also has diagnostic implications in newborn infants.
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