Gastric perforation following nasogastric tube insertion: a ......Gastric perforation following NGT...
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REFERENCES 1. Gary G. et al. Gastrointest Radiol 1980;5:1 2. Daliya P. et al. Ann R Coll Surg Engl 2012;94:e210 3. Janicki A. et al. R I Med J 2015;98:45 4. Norma A. et al. Curr Opin Gastroenterol 2007;23:178 5. Lowham A. S. et al. Surg Endosc 1996;10:979 6. Van Dinter T. G. et al. Proc (Bayl Univ Med Cent) 2013;26:11 7. Farag S. et al. Am j Gastroenterol 1996;91:1863 8. Glüer S. et al. J Pediatr Surg. 2006;41:e57 9. Karunakara B.P. et al. Indian J Pediatr. 2004;71:661 Gastric perforation following nasogastric tube insertion: a rare complication of a very common procedure Pauline Aeschbacher, Andreas Lanitis, Gwaenaelle Aellen, Antoine Meyer, François Pugin, Bernhard Egger Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg METHODS We report the case of a 71 years old patient who underwent open spleno-pancreatectomy for a neuro- endocrine cancer of the pancreas with additional Intraductal Papillary Mucinous Neoplasm lesions. On the first postoperative day the patient presented with an ileus needing NGT-insertion. 3 days later the patient complained about pain in the left shoulder and hiccup and subdiaphragmatic abscess was suspected. CT- scan demonstrated gastric perforation with a perigastric fluid-air collection and the tip of the NGT in it (FIGURE 1). An immediately performed gastroscopy showed a small perforation in the middle of a complete normal gastric mucosa (FIGURE 2-3). The perforation site was closed by endoscopic clips and the collection drained by percutaneous pigtail drain placement. Due to the persistence of contrast extravasation from the stomach visualized by CT-scan 2 days later, the endoscopic procedure had to be repeated. Following that complete uneventful evolution with discharge home of the patient 21 days after the pancreas operation. DISCUSSION Gastric perforation following NGT insertion is a rare but severe complication. It is well associated with the above mentioned risk factors. However, perforation is also possible without any risk factors. In order to prevent further complications, rapid diagnosis and treatment are essential. In the absence of generalized peritonitis, endoscopic clip closure of the perforation together with percutaneous drainage of the collection seems to be a good alternative to surgery. BACKGROUND Nasogastric tube (NGT) insertion is a very common procedure. Gastric perforation following NGT insertion is a very rare but severe complication. We present here such a case and a review of the literature. FIGURE 1: Injected CT scan: Tip of NGT outside of the stomach in an infra-diaphragmatic collection (red arrow) RESULTS In the literature, a total of 12 cases of gastric perforation following NGT insertion have been reported. Potential risk factors (severe gastritis, gastric ulceration, gastric necrosis, gastric cancer, gastric bypass operation, preterm or low birth weight children as well as chronic steroid use) were identified in 9 cases. In one case, the patient was known for a fibromuscular dysplasia, which could have also been a risk factor. In one publication potential risk factors have not been mentioned and in the last case; similar to our case, no risk factors could be identified. The treatment consisted mostly in laparotomy with direct suture of the perforation. FIGURE 2: Endoscopic view of the nasogastric tube going through the stomach wall FIGURE 3: Endoscopic view of the gastric perforation (red arrow) in a normal mucosa and the perforation closed by clips
Transcript of Gastric perforation following nasogastric tube insertion: a ......Gastric perforation following NGT...
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REFERENCES1. Gary G. et al. Gastrointest Radiol 1980;5:12. Daliya P. et al. Ann R Coll Surg Engl 2012;94:e2103. Janicki A. et al. R I Med J 2015;98:454. Norma A. et al. Curr Opin Gastroenterol 2007;23:1785. Lowham A. S. et al. Surg Endosc 1996;10:9796. Van Dinter T. G. et al. Proc (Bayl Univ Med Cent) 2013;26:117. Farag S. et al. Am j Gastroenterol 1996;91:18638. Glüer S. et al. J Pediatr Surg. 2006;41:e579. Karunakara B.P. et al. Indian J Pediatr. 2004;71:661
Gastric perforation following nasogastric tube insertion: a rare complication of a very
common procedurePauline Aeschbacher, Andreas Lanitis, Gwaenaelle Aellen, Antoine Meyer, François Pugin, Bernhard Egger
Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg
METHODS
We report the case of a 71 years old patient whounderwent open spleno-pancreatectomy for a neuro-endocrine cancer of the pancreas with additionalIntraductal Papillary Mucinous Neoplasm lesions. Onthe first postoperative day the patient presented with anileus needing NGT-insertion. 3 days later the patientcomplained about pain in the left shoulder and hiccupand subdiaphragmatic abscess was suspected. CT-scan demonstrated gastric perforation with a perigastricfluid-air collection and the tip of the NGT in it (FIGURE1). An immediately performed gastroscopy showed asmall perforation in the middle of a complete normalgastric mucosa (FIGURE 2-3). The perforation site wasclosed by endoscopic clips and the collection drainedby percutaneous pigtail drain placement. Due to thepersistence of contrast extravasation from the stomachvisualized by CT-scan 2 days later, the endoscopicprocedure had to be repeated. Following that completeuneventful evolution with discharge home of the patient21 days after the pancreas operation.
DISCUSSION
Gastric perforation following NGT insertion is a rare butsevere complication. It is well associated with the abovementioned risk factors. However, perforation is alsopossible without any risk factors. In order to preventfurther complications, rapid diagnosis and treatment areessential. In the absence of generalized peritonitis,endoscopic clip closure of the perforation together withpercutaneous drainage of the collection seems to be agood alternative to surgery.
BACKGROUND
Nasogastric tube (NGT) insertion is a very commonprocedure. Gastric perforation following NGT insertionis a very rare but severe complication. We present heresuch a case and a review of the literature.
FIGURE 1: Injected CT scan: Tip of NGT outside of the stomachin an infra-diaphragmatic collection (red arrow)
RESULTS
In the literature, a total of 12 cases of gastric perforationfollowing NGT insertion have been reported. Potentialrisk factors (severe gastritis, gastric ulceration, gastricnecrosis, gastric cancer, gastric bypass operation,preterm or low birth weight children as well as chronicsteroid use) were identified in 9 cases. In one case, thepatient was known for a fibromuscular dysplasia, whichcould have also been a risk factor. In one publicationpotential risk factors have not been mentioned and inthe last case; similar to our case, no risk factors couldbe identified. The treatment consisted mostly inlaparotomy with direct suture of the perforation.
FIGURE 2: Endoscopic view of the nasogastric tube goingthrough the stomach wall
FIGURE 3: Endoscopic view of the gastric perforation (red arrow) in a normal mucosa and the perforation closed by clips
