[Pneumothorax following nasogastric feeding tube insertion : Case report and review of the literature]

Abstract

A 54-year-old alcohol-dependant male patient suffering from severe alcohol withdrawal syndrome had to be intubated and artificially ventilated because of autonomic instability, convulsions and pulmonary dysfunction. A nasogastric tube (NGT) was inserted for enteral feeding and although placement was difficult the NGT was finally inserted after repeated attempts. Correct positioning of the NGT was evaluated by clinical means using insufflation of air and epigastric auscultation. As a typical "bubble" sound was epigastrically audible it has been assumed that the NGT was in the correct position. However, a routine control chest X-ray revealed a right-sided pneumothorax due to misplaced insertion of the tube into the bronchial system. Furthermore the patient developed massive cutaneous emphysema. The pneumothorax was treated successfully using pleural drainage. The patient was transferred to a peripheral ward 3 weeks after admission to the intensive care unit. The presented case report shows the importance of a correct position control of NGTs to avoid severe complications.