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Editor’s quiz: GI snapshot
Case of nasogastric tube dysfunction
  1. Florian Rainer1,
  2. Guenther Prenner2,
  3. Lukas Peter Binder1,
  4. Peter Fickert1,
  5. Johannes Plank1
  1. 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
  2. 2 Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
  1. Correspondence to Dr Florian Rainer, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz 8036, Austria; florian.rainer{at}medunigraz.at

Abstract

Clinical presentation An elderly female patient was admitted to intensive care for prolonged vasopressor therapy and mechanical ventilation after cardiac arrest and acute percutaneous coronary intervention. Antiplatelet, thyroid hormone replacement and statin therapies were administered through a 14-French nasogastric tube (Nestlé Health Science) and enteral feeding was initiated. Correct position of the nasogastric tube was confirmed radiologically. On the seventh day in the intensive care, our patient was seen to regurgitate soft crumbs into her mouth. The blocked nasogastric tube was removed, but attempts to reinsert another tube failed.

Upper GI endoscopy revealed an obstruction of the oesophagus with a milky-yellowish caseous substance 20 cm from the incisors (figure 1). The proximal part of the mass showed a central hole and ring-shaped layers resembling the cut face of a tree trunk.

Figure 1
Figure 1

Obstruction of the oesophagus with a milky-yellowish caseous substance.

Questions What caused the obstruction?

How should we manage such a problem?

  • nutrition
  • oesophageal disorders
  • bezoar

https://doi.org/10.1136/gutjnl-2017-315619

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    Footnotes

    • Contributors FR, GP, LPB, PF and JP: design, acquisition of data and drafting of manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.