Complications of Gastrointestinal Intubation

  • Gary G. Ghahremani
Part of the Radiology of Iatrogenic Disorders book series (IATROGENIC)


In 1790 the British physician John Hunter first introduced gastric intubation as an artificial means of feeding a paralyzed patient (1). During the last century William Beaumont’s classic studies of gastric juice led to further utilization of such tubes in the analysis of digestive functions of the stomach (2). More recently, however, technical refinements have made gastrointestinal intubation a routine procedure in medical and surgical management of many abdominal disorders. The principal application of this technique is in intestinal decompression in patients with obstructive symptoms or paralytic ileus (3,4). Flexible tubes are also placed into the gastrointestinal tract for various other diagnostic or therapeutic purposes, including alimentation with liquefied food (5–7), hypotonic duodenography, enteroclysis, gastrointestinal secretory tests, and mucosal biopsy (8–13).


Esophageal Stricture Esophageal Perforation Ischemic Colitis Cervical Esophagus Pneumatic Dilatation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Palmer JS: The Complete Works of John Hunter, vol 4. Philadelphia: Haswell, Barrington & Haswell 1841, p 185Google Scholar
  2. 2.
    Ingelfinger FJ: Tubes. Gastroenterology 74: 310–318, 1978Google Scholar
  3. 3.
    Cantor MO: Intestinal Intubation. Springfield, 111.: Thomas 1949Google Scholar
  4. 4.
    Harris FI, Gordon M: Intestinal intubation in small bowel distention and obstruction: Further experiences with the single lumen mercury weighted tube and analysis of complications. Surg Gynecol Obstet 86: 647–658, 1948PubMedGoogle Scholar
  5. 5.
    Rhea JW, Ghazzawi O, Weidman W: Nasojejunal feeding: An improved device and intubation technique. J Pediatr 82: 951–954, 1973PubMedCrossRefGoogle Scholar
  6. 6.
    Pareira MD, Conrad EJ, Hicks W, et al: Therapeutic nutrition with tube feeding. JAMA 156: 810–816, 1954Google Scholar
  7. 7.
    Fallis LS, Barron J: Gastric and jejunal alimentation with fine polyethylene tubes. Arch Surg 65: 373–381, 1952Google Scholar
  8. 8.
    Bilbao MK, Frische LH, Dotter CT, et al: Hypotonie duodenography. Radiology 89: 438–443, 1967PubMedGoogle Scholar
  9. 9.
    Eaton SB, Benedict KT, Ferrucci JT, et al: Hypotonie duodenography. Radiol Clin North Am 8: 125–137, 1970PubMedGoogle Scholar
  10. 10.
    Herlinger H: A modified technique for the double-contrast small bowel enema. Gastrointest Radiol 3: 201–207, 1978PubMedCrossRefGoogle Scholar
  11. 11.
    Hall WH, Hodges SC: Effect of fluoroscopic tube placement on basal gastric secretion collections. South Med J 69: 164–166, 1976PubMedCrossRefGoogle Scholar
  12. 12.
    Palmer ED: Duodenal intubation. JAMA 233: 818–819, 1975CrossRefGoogle Scholar
  13. 13.
    Flick AL, Quinton WE, Rubin CE: A peroral hydraulic biopsy tube for multiple sampling at any level of the gastrointestinal tract. Gastroenterology 40: 120–126, 1961PubMedGoogle Scholar
  14. 14.
    Astley R, Roberts KD: Intubation perforation of the esophagus in the newborn baby. Br J Radiol 43: 219–223, 1970PubMedCrossRefGoogle Scholar
  15. 15.
    Boros SJ, Reynolds JW: Duodenal perforation: A complication of neonatal nasojejunal feeding. J Pediatr 85: 107–108, 1974PubMedCrossRefGoogle Scholar
  16. 16.
    Chen JW, Wong PWK: Intestinal complications of nasojejunal feeding in low-birth-weight infants. J Pediatr 85: 109–110, 1974PubMedCrossRefGoogle Scholar
  17. 17.
    Girdany BR, Sieber WK, Osman MZ: Traumatic pseudodiverticulums of the pharynx in newborn infants. N Engl J Med 280: 237–240, 1969PubMedCrossRefGoogle Scholar
  18. 18.
    Kassner EG, Baumstark A, Balsam D, et al: 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, 1977Google Scholar
  19. 19.
    Lee SB, Kuhn JP: Esophageal perforation in the neonate. A review of the literature. Am J Dis Child 130: 325–329, 1976PubMedGoogle Scholar
  20. 20.
    Siegle RL, Rabinowitz JG, Sarasohn C: Intestinal perforation secondary to nasojejunal feeding tubes. Am J Roentgenol 126: 1229–1232, 1976Google Scholar
  21. 21.
    Sun SC, Samuels S, Lee J, et al: Duodenal perforation: A rare complication of neonatal nasojejunal tube feeding. J Pediatr 55: 371–375, 1975Google Scholar
  22. 22.
    Bruny SJA: Hazards of intestinal intubation. Am J Roentgenol 79: 862–865, 1958Google Scholar
  23. 23.
    Hafner CD, Wylie JH Jr, Brush BE: Complications of gastrointestinal intubation. Arch Surg 83: 147–160, 1961PubMedGoogle Scholar
  24. 24.
    Rozanski J, Kleinfeld M: A complication of prolonged intestinal intubation: Gaseous distention of the terminal balloon. Am J Dig Dis 20:1067– 1070, 1975Google Scholar
  25. 25.
    Siemers PT, Reinke RT: Perforation of the naso-pharynx by nasogastric intubation: A rare cause of left pleural effusion and pneumomediastinum. Am J Roentgenol 127: 341–343, 1976Google Scholar
  26. 26.
    Sower N, Wratten GP: Intussusception due to intestinal tubes. Case reports and review of literature. Am J Surg 110: 441–444, 1965PubMedCrossRefGoogle Scholar
  27. 27.
    Adams CL: The complications of endoesophageal tubes. J Thorac Cardio vase Surg 51: 685–693, 1966Google Scholar
  28. 28.
    Zeid SS, Young PD, Reeves JT: Rupture of the esophagus after introduction of the Sengstaken-Blakemore tube. Gastroenterology 36: 128–131, 1959PubMedGoogle Scholar
  29. 29.
    Seebacher J, Nozik D, Mathieu A: Inadvertent intracranial introduction of a nasogastric tube, a complication of severe maxillofacial trauma. Anesthesiology 42: 100–102, 1975PubMedCrossRefGoogle Scholar
  30. 30.
    Stauffer JL, Petty TL: Accidental intubation of the pyriform sinus. A complication of “roadside” resuscitation. JAMA 237: 2324–2325, 1977PubMedCrossRefGoogle Scholar
  31. 31.
    Wolff AP, Kessler S: Iatrogenic injury to the hypopharynx and cervical esophagus: An autopsy study. Ann Otolaryngol 82: 778–783, 1973Google Scholar
  32. 32.
    Tubes in the oesophagus (editorial). Lancet 1: 491–492, 1974Google Scholar
  33. 33.
    Iglauer S, Molt WF: Severe injury to the larynx resulting from indwelling duodenal tube. Ann Otol 48: 886–892, 1939Google Scholar
  34. 34.
    Nagler R, Spiro HM: Persistent gastroesophageal reflux induced during prolonged gastric intubation. N Engl J Med 269: 495–500, 1963PubMedCrossRefGoogle Scholar
  35. 35.
    Lucaya J, Herrera M, Salcedo S: Traumatic pharyngeal pseudodiverticulum in neonates and infants. Two case reports and review of the literature. Pediatr Radiol 8: 65–69, 1979PubMedCrossRefGoogle Scholar
  36. 36.
    Hirsch M, Abramowitz HB, Shapira S, et al: Hypopharyngeal injury as a result of attempted endotracheal intubation. Radiology 128: 37–39, 1978PubMedGoogle Scholar
  37. 37.
    Wolff AP, Kuhn FA, Ogura JH: Pharyngeal-esophageal perforations associated with rapid oral endotracheal intubation. Ann Otolaryngol 81: 258–261, 1972Google Scholar
  38. 38.
    Meyers MA, Ghahremani GG: Complications of fiberoptic endoscopy. I. Esophagoscopy and gastroscopy. Radiology 115: 293–300, 1975PubMedGoogle Scholar
  39. 39.
    Meyers MA, Ghahremani GG: Complications of gastrointestinal fiberoptic endoscopy. Gastroin-test Radiol 2: 273–280, 1977CrossRefGoogle Scholar
  40. 40.
    Eklóf O, Lóhr G, Okmian L: Submucosal perforation of the esophagus in the neonate. Acta Radiol (Diagn) 8: 187–192, 1969Google Scholar
  41. 41.
    Lynch FP, Coran AG, Cohen SR, et al: Traumatic esophageal pseudodiverticula in the newborn. J Pediatr Surg 9: 675–681, 1974PubMedCrossRefGoogle Scholar
  42. 42.
    Sengstaken RW, Blakemore AH: Balloon tamponade for the control of hemorrhage from esophageal varices. Ann Surg 131: 781–789, 1950PubMedCrossRefGoogle Scholar
  43. 43.
    Conn HO, Simpson JA: Excessive mortality associated with balloon tamponade of bleeding varices. A critical reappraisal. JAMA 202:587– 591, 1967Google Scholar
  44. 44.
    Conn HO: Hazards attending the use of esophageal tamponade. N Engl J Med 259: 701–707, 1958PubMedCrossRefGoogle Scholar
  45. 45.
    Hermann RE, Traul D: Experience with the Sengstaken-Blakemore tube for bleeding esophageal varices. Surg Gynecol Obstet 130: 879–885, 1970PubMedGoogle Scholar
  46. 46.
    Juffe A, Tellez G, Eguaras MG, et al: Unusual complication of the Sengstaken-Blakemore tube. Gastroenterology 72: 724–725, 1977PubMedGoogle Scholar
  47. 47.
    Bouchier IAD: Impaction of the Sengstaken-Blakemore tube. Gastroenterology 45: 274–278, 1963PubMedGoogle Scholar
  48. 48.
    Linton RR: The emergency and definitive treatment of bleeding esophageal varices. Gastroenterology 24: 1–9, 1953PubMedGoogle Scholar
  49. 49.
    Rosoff L, White EJ: Perforation of the esophagus. Am J Surg 128: 207–215, 1974PubMedCrossRefGoogle Scholar
  50. 50.
    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, 1963PubMedGoogle Scholar
  51. 51.
    O’Connor T, Watson R, Lepley D Jr, et al: Esophageal prosthesis for palliative intubation. Arch Surg 87: 257–279, 1963Google Scholar
  52. 52.
    Peura DA, Heit HA, Johnson LF, et al: Esophageal prosthesis in cancer. Am J Dig Dis 23: 796–800, 1978PubMedCrossRefGoogle Scholar
  53. 53.
    Girardet RE, Ransdell HT Jr, Wheat MW Jr: Palliative intubation in the management of esophageal carcinoma. Ann Thorac Surg 18: 417–427, 1974PubMedCrossRefGoogle Scholar
  54. 54.
    Palmer ED: Peroral prosthesis for management of incurable esophageal carcinoma. Am J Gastroenterol 59: 487–498, 1973PubMedGoogle Scholar
  55. 55.
    Mackenzie AS, Whyte AS, Tankel HI: Structural deterioration in Celestin tubes. Br J Surg 63: 851–852, 1976PubMedCrossRefGoogle Scholar
  56. 56.
    Bartlett RH: A procedure for management of acquired tracheoesophageal fistula in ventilator patients. J Thorac Cardiovasc Surg 71: 89–95, 1976PubMedGoogle Scholar
  57. 57.
    Thomas AN: Management of tracheoesophageal fistula caused by cuffed tracheal tubes. Am J Surg 124: 181-189Google Scholar
  58. 58.
    Moessinger AC, Driscoll JM Jr, Wigger HJ: High incidence of lung perforation by chest tube in neonatal pneumothorax. J Pediatr 92: 635–637, 1978PubMedCrossRefGoogle Scholar
  59. 59.
    Stahly TL, Tench WD: Lung entrapment and infarction by chest tube suction. Radiology 122: 307–309, 1977PubMedGoogle Scholar
  60. 60.
    Johnson KR, Genovesi MG, Lassar KH: Esophageal obturator airway: Use and complications. J Am Coll Emerg Physician 5: 36–39, 1976CrossRefGoogle Scholar
  61. 61.
    Pilcher DB, DeMeules JE: Esophageal perforation following use of esophageal airway. Chest 69: 377–380, 1976PubMedCrossRefGoogle Scholar
  62. 62.
    Scholl DG, Tsai SH: Esophageal perforation following the use of the esophageal obturator airway. Radiology 122: 315–316, 1977PubMedGoogle Scholar
  63. 63.
    Carlson WJ, Hunter SW, Bonnabeau RC Jr: Esophageal perforation with obturator airway. JAMA 241: 1154–1155, 1979PubMedCrossRefGoogle Scholar
  64. 64.
    Stewart ET, Miller WN, Hogan WJ, et al: Desirability of roentgen esophageal examination immediately after pneumatic dilatation for achalasia. Radiology 130: 589–591, 1979PubMedGoogle Scholar
  65. 65.
    Zegel HG, Kressel HY, Levine GM, et al: Delayed esophageal perforation after pneumatic dilatation for the treatment of achalasia. Gastrointest Radiol 4: 219–221, 1979PubMedCrossRefGoogle Scholar
  66. 66.
    Berry BE, Ochsner JL: Perforation of the esophagus. A 30 year review. J Thorac Cardiovasc Surg 65: 1–7, 1973PubMedGoogle Scholar
  67. 67.
    Banfield WJ, Hurwitz AL: Esophageal stricture associated with nasogastric intubation. Arch Intern Med 134: 1083–1086, 1974PubMedCrossRefGoogle Scholar
  68. 68.
    Waldman I, Berlin L: Stricture of the esophagus due to nasogastric intubation. Am J Roentgenol 94: 321–324, 1965Google Scholar
  69. 69.
    Douglas WK: Esophageal strictures associated with gastroduodenal intubation. Br J Surg 43: 404–409, 1955CrossRefGoogle Scholar
  70. 70.
    Ghahremani GG, Turner MA, Port RB: Iatrogenic intubation injuries of the upper gastrointestinal tract in adults. Gastrointest Radiol 5: 1–10, 1980PubMedCrossRefGoogle Scholar
  71. 71.
    Drenick EJ, Lipset M: Difficulty with removal of plastic nasogastric tube (letter). JAMA 218: 1573, 1971PubMedCrossRefGoogle Scholar
  72. 72.
    Barton CH, Vaziri ND, Ness RL, et al: Cimetidine in the management of metabolic alkalosis induced by nasogastric drainage. Arch Surg 114: 70–74, 1979PubMedGoogle Scholar
  73. 73.
    Larsen PD: Knotted nasogastric tubing. JAMA 238: 211–212, 1977PubMedCrossRefGoogle Scholar
  74. 74.
    Morris HH: Nasogastric intubation: A potentially knotty problem (letter). JAMA 237: 1432, 1977PubMedCrossRefGoogle Scholar
  75. 75.
    Shulman H: Passing the Cantor tube in a patient with a gastroenterostomy: An unusual complication. Am J Roentgenol 110: 332–333, 1970Google Scholar
  76. 76.
    Cantor MO: Intestinal intubation (letter). JAMA 205: 251, 1968PubMedCrossRefGoogle Scholar
  77. 77.
    Rennel CL: Intubation with telescoping of small bowel. Radiology 97: 155–156, 1970Google Scholar
  78. 78.
    McGoon DC: Intussusception: Hazard of intestinal intubation. Surgery 40: 515–519, 1956PubMedGoogle Scholar
  79. 79.
    Simonowitz D, Paloyan D: Intussusception associated with intestinal intubation. Illinois M J 155: 21–23, 1979Google Scholar
  80. 80.
    Poppel MH, Brinsley B: Ileal intussusception as result of intestinal intubation. JAMA 169:1189– 1190, 1959Google Scholar
  81. 81.
    Coffey ME, Gordon MJ, Mayes GR: Gaseous distention of an intestinal tube bag relieved by transabdominal puncture. Ann Intern Med 85: 480–481, 1976PubMedGoogle Scholar
  82. 82.
    Coleman SL, Miller WE, Stroehlein JR, et al: Nonoperative retrieval of an impacted long intestinal tube. Am J Dig Dis 22: 462–464, 1977PubMedCrossRefGoogle Scholar
  83. 83.
    Fricke FJ, Niewodowski MA: Hazardous gaseous distention of intestinal balloons. JAMA 235: 2611–2613, 1976PubMedCrossRefGoogle Scholar
  84. 84.
    Herschman A, Phillips JC: Knotted intestinal decompression tube (letter). JAMA 204: 634, 1968PubMedCrossRefGoogle Scholar
  85. 85.
    Khan JH, Cooper HF: Intestinal intubation (letter). JAMA 205: 251–252, 1968CrossRefGoogle Scholar
  86. 86.
    De Barros SG, Lane MF, Trotman BW: Longtube coiling in enterocolonic fistula. JAMA 241: 2636, 1979PubMedCrossRefGoogle Scholar
  87. 87.
    Dobbins WO, Trier JS, Parkins RA, et al: A warning regarding the dangers of hydraulic biopsy in gastrointestinal research. Gastroenterology 45: 335–340, 1963PubMedGoogle Scholar
  88. 88.
    Meyers MA, Ghahremani GG, Govoni AF: Ischemic colitis associated with sigmoid volvulus: New observations. Am J Roentgenol 128: 591–595, 1977Google Scholar
  89. 89.
    Nelson JA, Daniels AU, Dodds WJ: Rectal balloons: Complications, causes, and recommendations. Invest Radiol 14: 48–59, 1979PubMedCrossRefGoogle Scholar
  90. 90.
    Ansell G: Complications in Diagnostic Radiology. Oxford: Blackwell 1974, pp 339–350Google Scholar
  91. 91.
    Rabinovitch J, Rabinovitch P: Massive bleeding from common bile duct caused by indwelling T-tube. Arch Surg 69: 849–852, 1954Google Scholar
  92. 92.
    Grove WJ: Biliary tract hemorrhage as a cause of hematemesis. Arch Surg 83: 67–72, 1961PubMedGoogle Scholar
  93. 93.
    Campbell DA: Discussion of Guynn VL, Reynolds JT: Surgical management of hemobilia. Arch Surg 83: 73–80, 1961Google Scholar
  94. 94.
    Moreaux J, Bismuth H, Lagneau P: Les hémobilies post-opértoires par lésion artérielle pédiculaire. Ann Chir 20: 368–375, 1966PubMedGoogle Scholar
  95. 95.
    Boijsen E, Gôthlin J, Hallbook T, et al: Preoperative angiographie diagnosis of bleeding aneurysms of abdominal viscera. Radiology 93: 781–791, 1969PubMedGoogle Scholar
  96. 96.
    Sandblom P, Mirkovitch V, Saegesser F: Formation and fate of fibrin clots in the biliary tract: A clinical and experimental study. Ann Surg 185: 356–366, 1977PubMedCrossRefGoogle Scholar
  97. 97.
    Grosfeld JL, Cooney DR, Smith J, et al: Intra-abdominal complications following ventriculo-peritoneal shunt procedures. Pediatrics 54:791– 796, 1974Google Scholar
  98. 98.
    Chuang VP, Fried AM, Oliff M, et al: Abdominal CSF pseudocyst secondary to ventriculoperito-neal shunt: Diagnosis by computed tomography in two cases. J Comput Assist Tomogr 2: 88–91, 1978PubMedCrossRefGoogle Scholar
  99. 99.
    Norfray JF, Henry HM, Givens JD, et al: Abdominal complications from peritoneal shunts. Gastroenterology 77: 337–340, 1979PubMedGoogle Scholar
  100. 100.
    Wood BP, Haller JO, Berdon WE, et al: Shunt metastases of pineal tumors presenting as a pelvic mass. Pediatr Radiol 8: 108–109, 1979PubMedCrossRefGoogle Scholar
  101. 101.
    Azimi F, Dinn WM, Naumann RA: Intestinal perforation. An infrequent complication of ventriculo-peritoneal shunts. Radiology 121: 701–702, 1976PubMedGoogle Scholar
  102. 102.
    Lee FA, Gwinn JL: Complications of ventriculo-peritoneal shunts. Ann Radiol 18: 471–478, 1975PubMedGoogle Scholar
  103. 103.
    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, 1975PubMedGoogle Scholar
  104. 104.
    Krebs RA, Burtiss BB: Bowel perforation. A complication of peritoneal dialysis using a permanent peritoneal cannula. JAMA 198: 486–487, 1966PubMedCrossRefGoogle Scholar
  105. 105.
    Mion CM, Boen ST: Analysis of factors responsible for the formation of adhesions during chronic peritoneal dialysis. Am J Med Sei 250: 675–679, 1965CrossRefGoogle Scholar
  106. 106.
    Rubin J, Oreopoulos DG, Lio TT, et al: Management of peritonitis and bowel perforation during chronic peritoneal dialysis. Nephron 16: 220–225, 1976PubMedCrossRefGoogle Scholar
  107. 107.
    Simkin EP, Wright FK: Perforating injuries of the bowel complicating peritoneal catheter insertion. Lancet 1: 64–67, 1968PubMedCrossRefGoogle Scholar
  108. 108.
    Vaamonde CA, Michael UF, Metzger RA, et al: Complications of acute peritoneal dialysis. J Chron Dis 28: 637–659, 1975PubMedCrossRefGoogle Scholar
  109. 109.
    Wiener SN, Vertes V, Shapiro H: The upper gastrointestinal tract in patients undergoing chronic dialysis. Radiology 92: 110–114, 1969PubMedGoogle Scholar
  110. 110.
    Lipschutz DE, Easterling RE: Spontaneous perforation of the colon in chronic renal failure. Arch Intern Med 132: 758–762, 1973PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1981

Authors and Affiliations

  • Gary G. Ghahremani

There are no affiliations available

Personalised recommendations