P3288 - Oh Nose! A Dislodged Nasal Trumpet Causing Complete Esophageal Obstruction

Gisela Ocasio, DO¹, Jesse Hartpence, DO¹, Jeremy Barber, DO^2
1McLaren Greater Lansing, Lansing, MI; ²Corewell Health, Grand Rapids, MI

Introduction: Nasal trumpets are used for oxygenation and ventilation of patients with acute respiratory failure/obstruction. Typically these are used as a temporary measure, but smaller more permanent devices can be placed. Damage to the intranasal passage and dislodgment into oropharynx are common complications associated with long term use of these devices. It is extremely rare for these devices to pass into the esophagus. If it occurs, chronic inflammatory changes from foreign body in the esophagus for prolonged periods of time can lead to stricturing disease and pain.

Case Description/Methods: Case of a 54 year old male with hx of CVA requiring permanent use of nasal trumpet presenting with complete esophageal obstruction. Presenting symptoms included abdominal pain/reflux for which EGD was completed. Index EGD showed upper esophageal stricture that could not be traversed with neonatal gastroscope. Further imaging included multilevel CT which revealed esophageal stricture with thickening and a possible foreign body vs stent identified in the distal esophagus. Repeat EGD with advanced endoscopist revealed similar findings of stricture no visualized object or stent. A wire guided CRE balloon could not be passed for dilation. Patient’s PEG tube tract was dilated and exam was completed with neonatal scope through the tract. An hourglass shaped double stricture at the GEJ without any visible foreign body or mass extending into the cardia was noted. After discussion with the patient’s DPOA decision was made to proceed with serial EGDs with dilation. Repeat EGD with dilation exposed a plastic tube at the distal esophagus consistent with a dislodged nasal trumpet causing obstruction. Chronic inflammatory changes caused multi-level strictures requiring serial dilation to allow for safe removal of foreign object with subsequent dilations for treatment of strictures.

Discussion: An extremely rare complication of nasal trumpet use is dislodgment into the esophagus causing esophageal obstruction and strictures. Our case presents an example of long term obstruction due to a dislodged nasal trumpet into the distal esophagus causing inflammatory changes and severe multi-level stricturing disease. Patient’s aphasia and limited symptom reporting contributed to delayed diagnosis/complications. There are very few if any cases reported that resemble this particular presentation as a complication of long term nasal trumpet use. Esophageal obstruction should be considered as a potential complication of nasal trumpet use.


Disclosures:


Gisela Ocasio, DO¹, Jesse Hartpence, DO¹, Jeremy Barber, DO². P3288 - Oh Nose! A Dislodged Nasal Trumpet Causing Complete Esophageal Obstruction, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.