Esophageal Perforation: A Complication of Nasogastric Tube Placement in Premature Infants
Article Outline
The nasogastric tube of a 7-day-old extremely premature infant (gestational age, 28 weeks; birthweight, 830 g) who received oral intubation and ventilator care since his birth was found to contain blood immediately after its insertion. With chest radiography, it was revealed that the tube had exited the aerodigestive tract at the level of the seventh thoracic vertebra, tracked inferiorly to below right hemidiaphragm (Figure, A). Another nasogastric tube was placed while the first one remained in place (Figure, B). A lateral view was taken at the same time and revealed that the first tube was in the posterior mediastinum, whereas the second tube was properly placed in the stomach (Figure, C). The first tube was removed after radiography confirmation, and the patient was given a 1-week course of intravenous antibiotics, and then tube feeding was started without any complication.
Figure.
A, The chest radiograph showing a suspected misplacement of nasogastric tube (arrow A). B, Another tube (arrow B) was placed, while the first tube (arrow A) remained in place. C, Lateral view chest radiograph revealed that the first tube (arrow A) was in the posterior mediastinum, whereas the second tube (arrow B) was in the stomach.
Perforations of the esophagus in premature infants during insertion of nasogastric tubes are not uncommon. A suspicion of esophageal perforation demands immediate diagnostic examination, usually beginning with chest radiography that often shows signs of pneumothorax or pneumomediastinum, subcutaneous emphysema, or pleural effusion. Although plain radiography is usually positive for above described findings, negative results with radiography alone is insufficient to rule out a perforation. The choice of treatment varies according to the cause and specific location of the perforation and the time to recognition. The most important prognostic factor is the time that has passed between the acquirement of the injury and the initiation of therapy.
We demonstrate the advantage of insertion of another nasogastric tube while the first one remains in place to prevent repeat passage through the iatrogenic injury site and the feasibility of lateral view chest radiography to confirm the misplacement of feeding tube in premature infants.1, 2, 3
References available at www.jpeds.com
References
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- . Complications related to feeding tube placement. Curr Opin Gastroenterol. 2007;23:178–182
- . Esophageal perforation in neonates: a report of seven cases from Kuwait. Kuwait Med J. 2005;37:203–206
PII: S0022-3476(08)00882-2
doi:10.1016/j.jpeds.2008.10.015
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