Case of nasogastric tube dysfunction

Area of Science:

• Gastroenterology
• Critical Care Medicine
• Medical Device Complications

Background:

• Elderly patients in intensive care often require nasogastric tubes for nutritional support and medication delivery.
• Percutaneous coronary intervention and cardiac arrest necessitate intensive care, including mechanical ventilation and vasopressor therapy.
• Nasogastric tube placement and enteral feeding are common in critically ill patients.

Observation:

• A patient developed regurgitation of food particles despite radiologically confirmed nasogastric tube placement.
• Attempts to reinsert a nasogastric tube failed due to an esophageal obstruction.
• Upper gastrointestinal endoscopy revealed a unique, tree-trunk-like caseous mass obstructing the esophagus.

Findings:

• The esophageal obstruction was identified as a firm, milky-yellowish caseous substance.
• The mass exhibited ring-shaped layers, similar to the cross-section of a tree trunk.
• The obstruction occurred 20 cm from the incisors, significantly impeding passage.

Implications:

• This case highlights a rare complication of nasogastric tube use and enteral feeding.
• The unusual nature of the caseous substance suggests a potential link to specific feeding formulas or patient physiology.
• Further investigation is needed to understand the etiology and optimal management of such esophageal obstructions.