Routine Orogastric Tube Placement Reveals an Unexpected Diagnosis Resulting in a Change in Therapy: A Case Report

We describe the case of a pediatric patient scheduled for a magnetic resonance enterography (MRE) requiring oral contrast, and in whom an orogastric tube (OGT) was placed after the induction of anesthesia. Unexpectedly, OGT placement required three attempts, although the final placement was smooth. This prompted the anesthesiologist to order a chest radiograph, which was suspicious for an esophageal perforation. Further investigation with an esophagram revealed a previously undiagnosed paraesophageal hernia and an intrathoracic stomach and ruled out an esophageal perforation. A reduced dose of contrast was administered to decrease the chances of aspiration because of the intrathoracic position of the gastro-esophageal junction, which results in an incompetent lower esophageal sphincter. The procedure was completed uneventfully. This case highlights the importance of confirming the OGT location before use. The case also underscores the need for anesthesiologists to perform a complete evaluation if OGT placement presents unusual challenges.