Abstract
Perforation of the hypopharynx, esophagus, and stomach complicated the insertion of flexible tubes in 11 adults. Nasogastric suction tubes were responsible for 5 instances of gastric perforation. Palliative intubation of obstructive carcinomas of the distal esophagus resulted in delayed perforation of the esophagus and stomach in 2 cases. The use of a Linton tube for decompression of bleeding varices caused esophageal rupture in 1 patient whereas 2 others developed pharyngoesophageal perforation due to misplaced endotracheal tubes. The remaining 1 case demonstrated penetration of a chest tube into the esophageal lumen. The radiographic features and mechanisms of these iatrogenic injuries are described and the pertinent literature is reviewed.
Similar content being viewed by others
References
Cantor MO: Intestinal Intubation. Charles C Thomas, Springfield, Ill, 1949
Pareira MD, Conrad EJ, Hicks W, Elman R: Therapeutic nutrition with tube feeding.JAMA 156:810–816, 1954
Rhea JW, Ghazzawi O., Weidman W: Nasojejunal feeding: an improved device and intubation technique.J Pediatr 82:951–954, 1973
Ingelfinger FJ: Tubes.Gastroenterology 74:310–318, 1978
Hall HW, Hodges SC: Effect of fluoroscopic tube placement on basal gastric secretion collections.South Med J 69:164–166, 1976
Palmer ED: Duodenal intubation.JAMA 233:818–819, 1975
Eaton SB, Benedict KT, Ferrucci JT, Fleischli DJ: Hypotonic duodenography.Radiol Clin North Am 8:125–137, 1970
Herlinger H: A modified technique for the double-contrast small bowel enema.Gastrointest Radiol 3:201–207, 1978
Astley R, Roberts KD: Intubation perforation of the esophagus in the newborn baby.Br J Radiol 43:219–223, 1970
Kassner EG, Baumstark A, Balsam D, Haller JO: Passage of feeding catheters into the pleural space: a radiographic sign of trauma to the pharynx and esophagus in the newborn.Am J Roentgenol 128:19–22, 1977
Siegle RL, Rabinowitz JG, Sarasohn C: Intestinal perforation secondary to nasojejunal feeding tubes.Am J Roentgenol 126:1229–1232, 1976
Banfield WJ, Hurwitz AL: Esophageal stricture associated with nasogastric intubation.Arch Intern Med 134:1083–1086, 1974
Hafner CD, Wylie JH Jr, Brush BE: Complications of gastrointestinal intubation.Arch Surg 83:147–160, 1961
Siemers PT, Reinke RT: Perforation of the nasopharynx by nasogastric intubation: a rare cause of left pleural effusion and pneumomediastinum.Am J Roentgenol 127:341–343, 1976
Wolff AP, Kessler S: Iatrogenic injury to the hypopharynx and cervical esophagus: an autopsy study.Ann Otolaryngol 82:778–783, 1973
Linton RR: The emergency and definitive treatment of bleeding esophageal varices.Gastroenterology 24:1–9, 1953
Carter R, Hinshaw DB: Use of the Celestin indwelling plastic tube for inoperable carcinoma of the esophagus and cardia.Surg Gynecol Obstet 117:641–644, 1963
Nagler R, Spiro HM: Persistent gastroesophageal reflux induced during prolonged gastric intubation.N Engl J Med 269:495–500, 1963
Sower N, Wratten GP: Intussusception due to intestinal tubes. Case reports and review of literature.Am J Surg 110:441–444, 1965
Larsen PD: Knotted nasogastric tubing.JAMA 238:211–212, 1977
Rozanski J, Kleinfeld M: A complication of prolonged intestinal intubation: gaseous distention of the terminal balloon.Dig Dis 20:1067–1070, 1975
Drenick EJ: Difficulty with removal of plastic nasogastric tube (Letter).JAMA 218:1573, 1971
Lee SB, Kuhn JP: Esophageal perforation in the neonate. A review of the literature.Am J Dis Child 130:325–329, 1976
Hirsch M, Abramowitz HB, Shapira S, Barki Y: Hypopharyngeal injury as a result of attempted endotracheal intubation.Radiology 128:37–39, 1978
Wolff AP, Kuhn FA, Ogura JH: Pharyngeal-esophageal perforations associated with rapid oral endotracheal intubation.Ann Otolaryngol 81:258–261, 1972
Meyers MA, Ghahremani GG: Complications of fiberoptic endoscopy. I. Esophagoscopy and gastroscopy.Radiology 115:293–300, 1975
Girdany BR, Sieber WK, Osman MZ: Traumatic pseudodiverticulums of the pharynx in newborn infants.N Engl J Med 280:237–240, 1969
Adams CL: The complications of endoesophageal tubes.J Thome Cardiovasc Surg 51:685–693, 1966
Girardet RE, Ransdell HT Jr, Wheat MW Jr: Palliative intubation in the management of esophageal carcinoma.Ann Thorac Surg 18:417–427, 1974
Conn HO, Simpson JA: Excessive mortality associated with balloon tamponade of bleeding varices. A critical reappraisal.JAMA 202:587–591, 1967
Rosoff L, White EJ: Perforation of the esophagus.Am J Surg 128:207–215, 1974
Zeid SS, Young PD, Reeves JT: Rupture of the esophagus after introduction of the Sengstaken-Blakemore tube.Gastroenterology 36:128–131, 1959
Boros SJ, Reynolds JW: Duodenal perforation: a complication of neonatal nasojejunal feeding.J Pediatr 85:107–108, 1974
Chen JW, Wong PWK: Intestinal complications of nasojejunal feeding in low-birth-weight infants.J Pediatr 85:109–110, 1974
Schulhof LA, Worth RM, Kalsbeck JE: Bowel perforation due to peritoneal shunt. A report of seven cases and a review of the literature.Surg Neurol 3:265–269, 1975
Moessinger AC, Driscoll JM Jr, Wigger HJ: High incidence of lung perforation by chest tube in neonatal pneumothorax.J Pediatr 92:635–637, 1978
Stahly TL, Tench WD: Lung entrapment and infarction by chest tube suction.Radiology 122:307–309, 1977
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ghahremani, G.G., Turner, M.A. & Port, R.B. Iatrogenic intubation injuries of the upper gastrointestinal tract in adults. Gastrointest Radiol 5, 1–10 (1980). https://doi.org/10.1007/BF01888590
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01888590