Delayed Adult Gastric Perforation Following Insertion of a Feeding Nasogastric Tube

Although complications of a nasogastric tube (NGT) are identified and managed in daily clinical practice, gastric perforation following NGT insertion is a serious and rarely reported condition in adults. We present a case of a 71-year-old male who was brought to the hospital after having a cardiac arrest. Following stabilisation and receiving an emergency percutaneous coronary intervention (PCI), he was admitted to the intensive care unit (ICU), where he required NGT for feeding purposes. A few days later, abdominal distension was noted, and chest imaging was requested mainly for worsening respiratory parameters. A computed tomography (CT) scan confirmed gastric perforation and a misplaced NGT. Being a high-risk patient and in the absence of peritonism and frank sepsis, conservative management was adopted and included proton pump inhibitors (PPI), total parenteral nutrition (TPN), stomach aspiration via a Ryle tube and consideration of imaging-guided drainage. No risk factor for gastric perforation was identified in this presented case. The stable course of follow-up suggested sealed perforation; however, he died due to an extensive intracardiac thrombus. Though this incidence did not contribute directly to the patient’s death, it definitely added to the overall morbidity and negatively influenced the management of the other medical conditions. For complement, we also report a review of the ten similar cases in the literature, highlighting the associated risk factors, relevant clinical challenges, lines of management executed. The main aim of this case report is to enhance doctors' awareness of this serious complication, especially in patients with risk factors, and its diagnostic dilemmas. Early recognition and prompt intervention are recommended for a better outcome.