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.
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Berger R, Adams L (1989) Nutritional support in the critical care setting (part 2). Chest 96:372–380
Myo A, Nichols P, Rosin M, Bryant GDR, Peterson LM (1986) An unusual oesophageal obstruction during nasogastric feeding. Br Med J 293:596–597
Greaves E, Coladangelo RC (1989) Rhytobezoar formation encircling a disintegrated nasogastric tube in an unconscious patient. a case history. J Human Nutr Dietetics 2:155–157
Marcuard SP, Perkins AM (1988) Clogging of feeding tubes. JPEN 12:403–405
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 18:396–399
Cutie AJ, Altman E, Lenkel L (1983) Compatibility of enteral products with commonly employed drug additives.JPEN 7:186–191
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Turner, J.S., Fyfe, A.R., Kaplan, D.K. et al. Oesophageal obstruction during nasogastric feeding. Intensive Care Med 17, 302–303 (1991). https://doi.org/10.1007/BF01713943
- Enteral feeding