Alabdallat Mohammad, Strandvik Gustav, Afifi Ibrahim, Peralta Ruben, Parchani Ashok, El-Menyar Ayman, Rizoli Sandro, Al-Thani Hassan
Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic.
Case Rep Surg. 2023 Mar 29;2023:4230158. doi: 10.1155/2023/4230158. eCollection 2023.
. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. . We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated-and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. . Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.
在重症监护患者中，经口或经鼻途径进行肠内喂养是一种普遍的标准做法，总体安全性良好。然而，与鼻胃管（NGT）或口胃管（OGT）插入相关的并发症在医学文献中比拔除此类导管更为常见。我们报告了一名38岁男性，他遭遇机动车碰撞，在车外被发现格拉斯哥昏迷量表评分较低。他有多发性创伤，经口气管插管并通过OGT开始肠内喂养。在喂养管周围几天内形成了食管粪石，导致拔除时需要很大力气，结果并发食管穿孔。食管损伤经保守治疗后顺利康复。虽然文献中确实存在关于食管肠内喂养粪石形成的有限病例报告，但我们认为这是首例因食管粪石形成导致OGT嵌顿后强行拔除而引起食管穿孔的病例报告。与OGT/NGT相关的发病率并不常见，可能需要高度怀疑才能识别。在拔除NGT/OGT时如果感觉到阻力，情况尤其如此。建议尽早进行胃肠病学咨询以检测和处理任何并发症，但在这种稳定的病例中其作用非常有限。此外，可以考虑早期计算机断层扫描（CT）以便及时识别食管穿孔。对于稳定的患者可以考虑非手术治疗，特别是如果漏口在食管颈部。最后，预防胜于治疗，所以通过影像学检查并测量鼻孔/口腔处的导管长度来确认NGT/OGT位置，是避免误置和并发症的关键。该病例提高了医生对这种可预防医源性事件的认识。
