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| IMAGES IN MEDICINE |
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| Year : 2013 | Volume
: 59
| Issue : 4 | Page : 331-332 |
A rare cause of intraoperative nasogastric tube obstruction
P Kumar, S Yadav, S Saini, V Arora
Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| Date of Web Publication | 17-Dec-2013 |
Correspondence Address:
P Kumar
Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.123176
How to cite this article:
Kumar P, Yadav S, Saini S, Arora V. A rare cause of intraoperative nasogastric tube obstruction. J Postgrad Med 2013;59:331-2 |
| :: Case Report | |  |
A 19-year-old male was diagnosed with perforation peritonitis. He was hemodynamically stable and routine investigations were within normal limits. Nasogastic (NG) tube was inserted and attached to drainage bag for continuous aspiration of gastric content. Patient was taken up for exploratory laparotomy under general anesthesia. Appendicectomy and peritoneal lavage was done for gangrenous appendicular perforation. During closure, small bowel loops were distended, so nitrous oxide was turned off. To decompress the small bowel, reverse milking of its contents towards stomach was done by surgeon and NG tube aspiration (suction) was done. Initially fecal content was suctioned through NG tube, but later on no content could be aspirated despite stomach being distended by fluid contents. NG tube position was checked by surgeon. We tried to aspirate and then flush NG tube with 20 ml normal saline, but it could not be flushed. Despite maneuvering, aspiration was not possible through NG tube and it was taken out gently. We, unexpectedly, found the lumen of the NG tube occluded by Ascaris lumbricoides [Figure 1]. Another NG tube was inserted and surgery was completed uneventfully. | Figure 1: Ascaris lumbricoides obstructing the lumen of nasogastric tube
Click here to view |
| :: Discussion | | |
Blockage of the NG tube is a common problem despite its good care. Obstruction of NG tube can occur due to many causes like clogging by food or other solid particles or impaction of distal opening against the gastrointestinal mucosa. Rare causes of nasogastric tube obstruction have also been reported due to many reasons like self-knotting of the tube and presence of tapeworm in NG tube. [1],[2],[3]
Blockage of NG tube due to presence of Ascaris lumbricoides (round worm) in its lumen is uncommon. [4],[5] Upward migration of the worm from small intestine to the stomach is unlikely and unfavorable to worms. This is mainly due to the high gastric acidity. However, following intestinal obstruction, bile and pancreatic juice reflux might change the gastric environment and allows such migration. Reverse milking of small intestine contents in the direction of stomach physically pushes worm towards (into) stomach from where it can migrate into biliary tree, esophagus, naso- oral cavity, and the airway tract complicating patient outcome as well as may become one of rare cause of NG tube obstruction.
| :: Conclusion | | |
Occlusion by Ascaris could be considered as rare cause of NG tube obstruction, especially in endemic areas where the prevalence of disease is high.
| :: References | | |
| 1. | Mohsin M, Saleem Mir I, Hanief Beg M, Nasir Shah N, Arjumand Farooq S, Altaf Bachh A, et al. Nasogastric tube knotting with tracheoesophageal fistula: a rare association. Interact Cardiovasc Thorac Surg 2007;6:508-10. 
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| 2. | Elbashir MA, Abdalla M. A rare cause of nasogastric tube obstruction. Sudan Med J 2011;47:169-70.
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| 3. | Acharya AS, Mudholkar VG, Kulkarni AM, Namey RD. Ryles tube aspiration of tapeworm: An unusual presentation. Indian J Pathol Microbiol 2011;54:663-4.
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| 4. | Ortega R. An unusual cause of nasogastric tube obstruction. Anesth Analg 1992;75:147-8.
[PUBMED] |
| 5. | Gurjar M, Rao BP, Azim A. Unusual obstruction of nasojejunal feeding tube. Saudi J Gastroenterol 2009;15:288.
[PUBMED] |
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