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Intensive Care Medicine

, Volume 17, Issue 5, pp 302–303 | Cite as

Oesophageal obstruction during nasogastric feeding

  • J. S. Turner
  • A. R. Fyfe
  • D. K. Kaplan
  • A. J. Wardlaw
Case Reports

Abstract

Although complications of enteral feeding are usually minor, we report an unusual and serious case of oesophageal obstruction after feeding with osmolite, a commonly used polymeric enteral feeding preparation. The patient described underwent rigid oesophagoscopy to remove the feed which had solidified and blocked the entire oesophageal lumen. The procedure resulted in oesophageal perforation which needed surgical repair by thoracolapartomy and was followed by a difficult postoperative course. In vitro tests showed that all commonly used feeds containing casein (osmolite, ensure, ensure plus, paediasure, fortison, and pulmocare) solidified at a pH of less than 5. Clinifeed (containing dried skim milk) and peptamen (containing peptides) remained liquid at a pH of less than 1. Solidified feed could be liquefied by the addition of pepsin or pancrex V (a pancreatic enzyme formulation). We conclude that solidification could occur in all feeds containing casein and that alternative feeds should be considered in patients with increased gastric acidity. In addition, pepsin or pancrex V could be used to liquefy solidified feed.

Key words

Enteral feeding Nutrition Esophagus Caseins 

References

  1. 1.
    Berger R, Adams L (1989) Nutritional support in the critical care setting (part 2). Chest 96:372–380Google Scholar
  2. 2.
    Myo A, Nichols P, Rosin M, Bryant GDR, Peterson LM (1986) An unusual oesophageal obstruction during nasogastric feeding. Br Med J 293:596–597Google Scholar
  3. 3.
    Greaves E, Coladangelo RC (1989) Rhytobezoar formation encircling a disintegrated nasogastric tube in an unconscious patient. a case history. J Human Nutr Dietetics 2:155–157Google Scholar
  4. 4.
    Marcuard SP, Perkins AM (1988) Clogging of feeding tubes. JPEN 12:403–405Google Scholar
  5. 5.
    Caballero GA, Ausman RK, Quebbeman EJ, Schulte WJ, Lin L (1990) Gastric secretion pH measurement: what you see is not what you get. Crit Care Med 18:396–399Google Scholar
  6. 6.
    Cutie AJ, Altman E, Lenkel L (1983) Compatibility of enteral products with commonly employed drug additives.JPEN 7:186–191Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • J. S. Turner
    • 1
  • A. R. Fyfe
    • 1
  • D. K. Kaplan
    • 1
  • A. J. Wardlaw
    • 1
  1. 1.Adult Intensive Care UnitRoyal Brompton and National Heart HospitalLondonUK

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