An alternative method to differentiate pleural effusion after leakage of artificial enteral nutrition formula

This case report highlights a rare but fatal complication of artificial enteral nutrition due to feeding tube misplacement, leading to pleural effusion and respiratory failure. The primary objective was to determine whether enteral nutrition formula leakage contributed to the patient's death and to differentiate the pleural effusion from other possible etiologies, such as chylothorax.

A 59-year-old male patient with severe lung disease underwent left-sided partial lung resection and subsequently received enteral nutrition via a nasogastric feeding tube. After suspected feeding tube misplacement and formula leakage into the pleural cavity, autopsy and histological examination were performed. Cytological and chemical analyses, including gas chromatography-mass spectrometry, were employed to identify nutritional components in pleural effusion and to confirm the presence of enteral nutrition formula.

The autopsy revealed milky, turbid pleural effusion, aspiration pneumonia, and a rupture of the right visceral pleura. Cytological analysis confirmed granulocytic pleural empyema with rod-shaped Congo red-positive material resembling the enteral nutrition formula. Gas chromatography-mass spectrometry identified tricaprylin, a unique marker for enteral nutrition formula, confirming nutritional leakage into the pleural cavity.

This case study emphasizes the necessity for radiological confirmation of feeding tube placement and the implementation of comprehensive diagnostic protocols for suspected cases of nutritional fluid leakage. Gas chromatography-mass spectrometry proved invaluable in distinguishing nutritional effusions from other potential etiologies by enabling the specific identification of enteral formula components. The high specificity and adaptability of gas chromatography-mass spectrometry render it an essential tool for forensic investigations and clinical diagnostics involving complex fluid analyses, facilitating evidence-based conclusions in critical care and postmortem contexts.