Nasogastric Tube Syndrome: A Diagnostic Dilemma

Nasogastric tubes have been used in the pediatric age group to supplement nutrition in cases of malignancy and failure to thrive due to a variety of causes. Breathing difficulty may occur after the insertion of a nasogastric tube and it can have multiple causes. Here we discuss 2 patients of acute lymphoblastic leukemia (ALL) who developed a rare condition called the Sofferman syndrome (nasogastric tube syndrome). We will also briefly outline a diagnostic algorithm to facilitate its fast and correct diagnosis.

We present 2 cases of pediatric ALL who were undergoing chemotherapy in the pediatrics department. They presented with respiratory distress and stridor within a few days of nasogastric tube insertion.

Two cases of ALL developed stridor within 48 hours of nasogastric tube insertion. The stridor gradually progressed over days. Both the patients required tracheostomy to secure the airway. Removal of the nasogastric tube did not reverse the airway obstruction.

Nasogastric tube syndrome is a potentially life-threatening condition and has to be considered as a possibility in immune-compromised patients who present with voice change and stridor after nasogastric tube insertion.