Iatrogenic bronchopleural fistula caused by feeding tube insertion

Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.