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Oesophageal mucosal tears caused by suboptimal nasogastric tube insertion: a case study

10 December 2020
Focus
02 December 2020
Volume 29 · Issue 22

Abstract

Oesophageal bezoars are one of the many causes of nasogastric tube obstruction; however, they are extremely rare and, therefore, not often considered to be the cause of a blockage. A bezoar is a solid mass of indigestible material that accumulates in the digestive tract. After a blockage is identified, the nasogastric tube is usually removed and another one inserted. However, this can be dangerous and can easily cause tearing of the oesophageal mucosa, bleeding, and other serious complications. In this article, the authors present a case of nasogastric tube obstruction caused by oesophageal bezoars. After the nasogastric tube was replaced, the patient experienced two tears of the oesophageal mucosa. This article highlights the importance of the introduction of a procedure for nurses to follow in cases of nasogastric tube obstruction, bearing in mind the possibility of the presence of oesophageal bezoars. If necessary, a gastroscope should be used to ensure safe insertion of the nasogastric tube and prevent oesophageal mucosal tears.

Critically ill patients are often unable to maintain adequate nutritional intake to meet their metabolic needs. Therefore, nutritional support is often provided to these patients as part of their medical care (Padilla et al, 2016) most commonly provided via a nasogastric tube.

The most prevalent complications associated with the use of nasogastric tubes for providing enteral nutritional support include respiratory problems and diarrhoea (Gil-Almagro and Carmona-Monge, 2016). Digestive bezoars are uncommon; oesophageal bezoars are rare (Tawfic et al, 2010). Gastro-oesophageal reflux results in gastric acid and nutrient solution entering the oesophagus. If the oesophageal contents cannot be emptied quickly, long-term food retention forms hard oesophageal bezoars from the action of refluxed gastric juice and nutrient solution (Tawfic et al, 2010).

This article discusses a case of nasogastric tube obstruction and the occurrence of two oesophageal mucosal tears—serious iatrogenic injuries resulting from nasogastric tube reinsertion.

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Oesophageal bezoars
Nasogastric tube obstruction
Oesophageal mucosal tear
Nasogastric tube feeding