IS Case 337: Gastric perforation by the nasogastric tube

Veniamin Barshay, MD


Imaging Sciences URMC 2009
Publication Date: 2009-09-16

History

Patient is a 66-year-old female with lymphoma in the intensive care with fever and abdominal pain.

Findings

Abdomen CT scout showed apparently normal course of NG tube (Fig. 1). Abdominal CT demonstrated nasogastric tube perforating the stomach wall. There was a large pneumoperitoneum, as well as ascites and high attenuation fluid collection with flecks of air at the tip of the tube (probably tube feeds).

Diagnosis

Gastric perforation by the nasogastric tube

Discussion

Nasogastric intubation is commonly used in intensive care patients, as well as patients with gastrointestinal disorders. It is important in nutritional support of debilitated patients. However, numerous complications have been reported in association with tube malposition and prolong use. Among those are tracheobronchial intubation, nasopharyngeal perforation, and esophageal or gastric perforation. Gastric perforation is especially uncommon and difficult to diagnose. The auscultation of the left upper quadrant of the abdomen while injecting air, abdominal radiograph (as seen on the CT scout image here) can be both falsely negative.

References

  1. Lee SH, Kim MS, Kim KH, et al. Gastric perforation caused by nasogastric intubation in a patient on peritoneal dialysis, Korean J Nephrol 2007; 26: 250-253. [PDF]
  2. Bini A, Grazia M, Petrella F, Stella F, Bazzocchi R. Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube. Ann Thorac Surg. 2004 Jul;78(1):339-41. PMID: 15223464

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