Abstract
We report a 1 month old infant with a spontaneously knotted nasogastric tube. Attempted removal of the nasogastric tube was unsuccessful, prompting further investigation. Plain radiographs revealed a large, multi-looped knot impacted in the nasopharynx and oropharynx. The tube was subsequently removed through the mouth under general anesthesia without complication, revealing a large, impressive knot of the distal end of the nasogastric tube.
1
Introduction
Knotting of a nasogastric tube is a rare event that has been previously described in various case reports . A knotted nasogastric tube has potentially serious risks, including respiratory distress , entanglement with endotracheal tubes , tracheoesophageal fistula , and mucosal damage or laceration . It is thought that small caliber tubing and insertion of an excessive length of tubing are the main risk factors for creating a knot in a nasogastric tube .
2
Case report
A 24-day old male infant was admitted to hospital for sepsis, thought to be of urologic etiology. A nasogastric tube (NGT) was inserted due to poor oral intake and feeds were successfully initiated. Several days after admission, the patient was clinically improving and orders were placed to remove the NGT. Attempted removal of the NGT was unsuccessful. A significant amount of resistance occurred after partially removing the NGT and the patient developed stridor. Subsequent investigation with plain radiographs of the head and neck revealed that the NGT was coiled in multiple loops; a complex knot extended from the nasopharynx to the hypopharynx ( Fig. 1 ).
When seen in consultation by the otolaryngology service, the patient had mild biphasic stridor, worse when the infant was upset. There was some slight tracheal tug and tachypnea reported; vital signs were otherwise within normal limits. Given the potential for respiratory distress, epistaxis, soft palate laceration or difficult removal at the bedside, the patient was brought to the operating room for removal of the foreign body in a controlled setting. The tube was cut anterior to the nasal vestibule and secured. Several coiled loops of tubing were visualized in the oropharynx with direct laryngoscopy. Magill forceps where then used to retrieve the knotted tube through the oral cavity without complication. Examination of the tube after removal revealed a large, multi-looped knot ( Fig. 2 ). Flexible fibreoptic nasopharyngolaryngoscopy performed immediately after revealed no obvious trauma or abnormality. The patient recovered without any further complications.
2
Case report
A 24-day old male infant was admitted to hospital for sepsis, thought to be of urologic etiology. A nasogastric tube (NGT) was inserted due to poor oral intake and feeds were successfully initiated. Several days after admission, the patient was clinically improving and orders were placed to remove the NGT. Attempted removal of the NGT was unsuccessful. A significant amount of resistance occurred after partially removing the NGT and the patient developed stridor. Subsequent investigation with plain radiographs of the head and neck revealed that the NGT was coiled in multiple loops; a complex knot extended from the nasopharynx to the hypopharynx ( Fig. 1 ).
