A gastric tube used to decrease PONV resulted in a pneumothorax.  (Image source: A&A Case Reports)
A gastric tube used to decrease PONV resulted in a pneumothorax. (Image source: A&A Case Reports)

Not much is thought about inserting an orogastric tube.  Pharyngeal bleeding can occur. We sometimes cause sore throats. Most of us have attached an OG or NG tube to the ventilator and watched the bellows collapse, indicating we passed it into the trachea. But esophageal perforation and pneumothorax?

Dr. Ali A. Turabi, Department of Anesthesia, U.S. Army Medical Corps, Landstuhl Regional Medical Center, Landstuhl, Germany, and colleagues describe insertion of an orogastric tube for a patient who underwent right shoulder arthroscopy and distal clavicle excision under general anesthesia.  The complications of their case are discussed in the article titled “Esophageal Perforation and Pneumothorax after Routine Intraoperative Orogastric Tube Placement,” which was published in the 15 May 2014 issue of A&A Case Reports.

An OG tube was inserted at the end of the case but “mild resistance” was encountered.  The authors repositioned the patient and tried again. Resistance was again encountered, and the tube was again removed. When the tube was removed, about 50-70 mL of bright red blood came out of the gastric tube. Esophagogastroduodenoscopy performed by a gastroenterologist showed a single, linear, mucosal tear 39 cm from the teeth.  After the patient’s trachea was extubated, the patient was brought to the postanesthesia care unit.  Despite high flow oxygen, the patient’s oxygen saturation remained at 93-94%.  A chest radiograph in the PACU showed a left pneumothorax. A chest tube was placed and the patient was transferred to the ICU. An esophagram was ordered that revealed an esophageal perforation. This was managed conservatively with an esophageal stent. The stent was removed 2.5 weeks later, and no further therapy was required.

This is not the first time an esophageal perforation has occurred secondary to orogastric insertion, though it is unusual.  Gastric tubes are frequently used to help decrease PONV. A recent study published in this journal showed the contrary, namely that the routine use of gastric tubes does not reduce the incidence of PONV.