Cappell M S, Scarpa P J, Nadler S, Miller S H
Division of Gastroenterology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
J Clin Gastroenterol. 1992 Mar;14(2):144-7. doi: 10.1097/00004836-199203000-00015.
We report two complications of nasoenteral tubes. A nasogastric tube became knotted during gastric intubation in a patient with a small gastric remnant, created during gastric surgery for morbid obesity. A clogged Dobbhoff tube ruptured while it was being flushed manually with a syringe containing normal saline under great pressure. To retrieve the knotted tube, we grasped the distal knotted part visible in the oropharynx with forceps, pulled it out of the mouth, and cut it. To retrieve the broken tube, we snared the intragastric fragment at endoscopy. These case reports suggest that a small gastric remnant may be a risk factor for nasogastric tube coiling and knot formation and that flushing a clogged tube at high pressure may rupture it. To prevent these complications, a nasogastric tube should be carefully passed just into the stomach in a patient with a small gastric remnant, and a clogged feeding tube should be flushed with only moderate pressure. Failure to clear a blocked tube by flushing with normal saline at moderate pressure should lead to tube removal and not to use of excessive pressure.
我们报告了鼻肠管的两种并发症。在一名因病态肥胖接受胃手术而形成小胃残端的患者进行胃插管时，一根鼻胃管打结。一根堵塞的多布霍夫管在用装有生理盐水的注射器手动大力冲洗时破裂。为取出打结的管子，我们用钳子抓住口咽中可见的远端打结部分，将其从口中拉出并剪断。为取出断裂的管子，我们在内镜检查时套住胃内碎片。这些病例报告表明，小胃残端可能是鼻胃管盘绕和打结形成的危险因素，并且高压冲洗堵塞的管子可能导致其破裂。为预防这些并发症，对于有小胃残端的患者，应小心将鼻胃管插入胃内，并且堵塞的饲管应以适度压力冲洗。在以适度压力用生理盐水冲洗未能清除堵塞的管子时，应导致拔除管子而不是使用过大压力。
