Introduction: Nasogastric (NG) tubes play a variety of roles in critically ill patients including providing enteral nutrition and decompressing the upper GI tract. Dobhoff tubes are smaller and more flexible NG tubes that allow for a more comfortable placement with the primary purpose of providing enteral nutrition. Although NG tube placement is often thought of as a benign bedside procedure, it has been associated with a wide array of complications. Though less frequently described, life-threatening complications do occur and include pneumothorax, hemothorax, esophageal perforation, and nasogastric tube syndrome. We report a case of sub-mucosal invasion of a Dobhoff tube in a liver transplant patient.
Case Description/Methods: A 74-year-old female with a past medical history of decompensated non-alcoholic steatohepatitis cirrhosis status-post orthoptic liver transplant one month prior was evaluated for recurrent melena associated with acute blood loss anemia. On initial endoscopy, a Dobhoff tube with subepithelial invasion in the proximal esophagus was noted at 20-cm from incisors. No intra-luminal tube was seen throughout the length of esophagus distal to the entry point in the wall of esophagus. Tube emerged just distal to the gastroesophageal junction into the stomach (Figure A). Endoscopic ultrasound showed that the feeding tube was in the sub-mucosal layer of the esophagus wall. Feeding tube was carefully removed under direct endoscopic view without any issues. Patient was managed conservatively. Imaging studies did not show any perforation. Subsequently, a repeat EGD was performed for direct placement of the feeding tube in the jejunum.
Discussion: NG tubes are often indicated for nasogastric decompression in setting of small bowel obstruction, aspiration prevention in intubated patients, and administration of enteral nutrition. Although a low-risk procedure, NG tube placement and use is associated with complications. Despite its narrower lumen, Dobhoff tube is still subject to the same complications as NG tubes. In our patient, the encasement of Dobhoff tube was found incidentally on endoscopy for melena. This case presents an example of an unlikely complication which further iterates that extreme care must be taken in positioning and maintenance of NG tubes to avoid the adverse events associated with these devices.
Figure: Figure A: Sub-mucosal invasion of Dobhoff tube in esophagus
Shayan Amini indicated no relevant financial relationships.
Rajdeepsingh Waghela indicated no relevant financial relationships.
Shaadi Abughazaleh indicated no relevant financial relationships.
Ali Raza indicated no relevant financial relationships.
Shayan Amini, MD, Rajdeepsingh Waghela, MD, Shaadi Abughazaleh, MD, Ali Raza, MD. P0574 - Sub-Mucosal Invasion of a Dobhoff Tube in a Liver Transplant Patient, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.