Difficult tracheostomy decannulation related to nasogastric tube syndrome: A case report

INTRODUCTION AND IMPORTANCE: Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication. Patients receiving both tracheostomy and indwelling nasogastric tube (NGT) are not uncommon, however difficult tracheostomy decannulation due to NGTS has not been reported. CASE PRESENTATION: A 65-year-old woman was hospitalized with cervical spine stenosis and cervical spinal cord injury after a fall. The surgeon planned neck surgery, but unanticipated tracheotomy had to perform due to emergency airway during anesthesia induction. She then suffered from acute respiratory distress syndrome and underwent a series of treatments including indwelling NGT. About 2 weeks later, tracheostomy decannulation was planned. Following tracheostomy-tube-occlusion test, however, she experienced severe inspiratory difficulty. Severe supraglottic swelling was found, and the opening of glottis was completely covered by swollen tissue. Three weeks post-tracheostomy, the airway patency test failed again, and NGT was removed. Finally, the tracheostomy tube was successfully removed at 5 weeks after tracheotomy. CLINICAL DISCUSSION: This patient developed difficult tracheostomy decannulation due to upper airway obstruction, and NGTS was considered as the main cause. Although vocal cord paralysis and post-cricoid ulcer did not occur in this case, we suggest that severe periglottic swelling may also be a symptom of NGTS. In this patient, upper airway edema gradually relieved after NGT removal, and the artificial airway was also removed 2 weeks later. Therefore, removal of NGT is the primary measure to deal with NGTS. CONCLUSIONS: Attention should be paid to the effect of NGTS on decannulation in patients receiving long-term tracheotomy and NGT insertion.