Pakistan Journal of Medical Sciences

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ISSN 1681-715X

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CASE REPORT

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Volume 23

July - September 2007

Number  4


 

Abstract
PDF of this Article

Spontaneous knotting of ryles tube in a
post operative patient

Utpal De1, Akhilesh Agarwal2, Veena Singh3

Summary

Spontaneous knotting of nasogastric tube is a rare complication. A similar case encountered in a postoperative patient is reported.

KEY WORDS: Ryles tube, Knotting.

Pak J Med Sci   July - September 2007   Vol. 23 No. 4   641-642


1. Dr. Utpal De
Assistant Professor
2. Dr. Akhilesh Agarwal
Postgraduate Trainee
3. Dr. Veena Singh
Postgraduate Trainee
1-3: Department of Surgery
Calcutta Medical College and Hospital
88, College Street, Kolkata - 73,
West Bengal,
India.

Correspondence

Dr. Utpal De,
L-4/9, Phase- 3,
Dankuni Housing Complex ,
Dankuni Hooghly,
West Bengal,
India.
E-mail: utpalde@vsnl.net

* Received for Publication: February 8, 2007
* Accepted: June 4, 2007


INTRODUCTION

Naso-gastric tube insertion is a simple clinical procedure with occasional unexpected and life threatening complications.1-5 Majority of these occurs due to faulty insertion techniques.1 Complication rates vary widely from 0.3% to 8%.2 We present a case of spontaneous knotting of nasogastric tube.

CASE REPORT

A female patient of fifty-six years was admitted in female surgical ward with obstructive jaundice. Ultrasonography revealed chronic calculous cholecystitis with choledocholithiasis. She underwent cholecystectomy with choledocholithotomy. Besides other preoperative measures a nasogastric tube was introduced. When the patient had shown considerable postoperative improvement and nasogastric tube had become nonfunctional a decision was made to remove the tube on the fourth postoperative day. Attempts at removal were met with resistance and on further traction it came out causing visible nasal bleed. The tube was found knotted in its terminal part near its tip (Fig-1). A hemostatic nasal pack was left for twenty-four hours. A thorough nasolaryngeal examination was performed after removal of nasal pack. The postoperative period was uneventful and the patient was discharged on the tenth postoperative day after stitch removal. The patient is doing well after six months follow-up without any complications.

DISCUSSION

Nasogastric tube placement is often associated with minor and major complications.3,4 Minor complications include nasal irritation, epistaxis and sinusitis. Major complications are tracheobronchopleural complications, intravascular penetration, enteral complications and intracranial entry. Factors responsible for such complications include faulty insertion techniques, tube design, peristalsis of stomach, and anatomical abnormalities together with high threshold pressure during extraction.4

Confirmatory tests to detect tube position after insertion include X-ray and air insufflations with epigastric auscultation, pH of aspirate and bilirubin, capnography and endoscopy.5

High-risk cases prone to develop such complications include intubated and sedated patients, elderly mentally obtunded, following lung transplantation and repeated attempt after earlier pulmonary misadventure.4,5 Therefore, careful insertion together with high index of suspicion could minimize such complications.

REFERENCES

1. Beh T. Knotting of nasogastric tube. Anaesth Intensive Care 1998;26:116.

2. Mandal NG, Foxell R. Knotting of a nasogastric tube. Anaesthesia 2000;55:99.

3. Trujillo MH, Fragachan CF, Tortoledo F, Ceballos F. "Lariat loop" knotting of a nasogastric tube: an ounce of prevention. Am J Crit Care 2006;15:413-4.

4. Kamili MM, Bhat NA, Ahmad M, Kadla SA. Spontaneous knotting of nasogastric tube. J Assoc Physicians India 2000;48:253-4.

5. Roubenoff R, Ravich WJ. Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention. Arch Intern Med 1989;149:184-8.


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