Case Report

By Dr. Gaurav Bharadwaj , Dr. Prakash C Attri , Dr. Pramod Verma , Dr. Rupesh Rai , Dr. Vikas Jain , Dr. Atul Jain
Corresponding Author Dr. Gaurav Bharadwaj
General Surgery , Subharti Medical College , Meerut, E - 78 , Sector 3 , Sushant City - India 250005
Submitting Author Dr. Gaurav Bharadwaj
Other Authors Dr. Prakash C Attri
Subharti Medical College, Dept Of General Surgery , Meerut - India 250005

Dr. Pramod Verma
Subharti Medical College, Dept Of General Surgery , Meerut - India 250005

Dr. Rupesh Rai
Subharti Medical College, Dept Of General Surgery , Meerut - India 250005

Dr. Vikas Jain
Subharti Medical College , Dept Of General Surgery , Subharti Medical College , Meerut UP - India 250005

Dr. Atul Jain
Subharti Medical College , Dept Of General Surgery , Subharti Medical College , Meerut , UP - India 250005


Nasogastric tube fixation , Endoscopy , Iatrogenic complications of NG tube ,

Bharadwaj G, Attri PC, Verma P, Rai R, Jain V, Jain A. Iatrogenic Complications of NG Tube - Accidental Fixation to the Pylorus of Stomach - A Case Study and Review of literature. WebmedCentral GENERAL SURGERY 2013;4(6):WMC004098
doi: 10.9754/journal.wmc.2013.004098

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 14 Jun 2013 01:22:44 PM GMT
Published on: 15 Jun 2013 11:12:46 AM GMT


Nasogastric tube is used in almost all the patients for feeding and gastric decompression specially treated for GIT problems or head and neck injury / surgeries for variable lengths of time . It may be used for a few hours in patients with no or minimal  GI tract  tampering while in others , it is used for a considerably longer time where it is used for temporary drainage . In such cases , the success or the failure of the surgery depends almost entirely on the functioning of the nasogastric tube . How so ever simple it may seem but this apparently harmless use of NG tube comes with a few not so known complications . A number of complications have been reported with the NG tube ranging from iatrogenic nasogastric perforation(1) , retained nasogastric tube / stapled NG tube (2,3,4,5), knotted NGT(6,7,8), misplacement into the airways(9,10) , even cranial cavity (11)in head injury patients ,  leading to pneumothorax(12) , respiratory distress and respiratory tract infections (13), nasogastric tube syndrome(14,15) , haemorrhage and mediastinitis(16)

Case Report

A 47 yrs old male labourer from West Bengal was referred from a  private hospital for inability to  remove the  NG tube which was placed after surgery for gastric perforation . Two NG tubes were placed intra operatively . The first one in the stomach for evacuation and the second in the jejunum to start  early feeding .The NG tube placed in the stomach was withdrawn on the 5th post operative day while attempts were made to withdraw the one  placed in jejunum on the 12th day which were unsuccessful . The patient complained of acute pain in the mediastinum and epigastric region while attempting to remove the NG tube . The patient was referred for NG tube removal . X ray chest (PA) and X ray abdomen (AP erect ) were done to identify the location of the tube . When the position of the tube was confirmed to be in the Jejunum a OGD was advised  On OGD the NG tube was found to be tightly secured at the pylorus with a silk thread . The tube would have come in the bite while trying to suture the anterior wall of the perforation and got fixed at the site of perforation .  Endoscopic removal of the tube was not tried at this time as the tube was secured by the same knot which was used to hold the omental patch in position , so any manipulation of the knot was avoided at this time . After 2 weeks post operatively , the patient had wound dehiscence of the abdominal wall so the patient was kept on conservative management and a high protein diet to improve his nutritional status and give time for the  patch to get properly adhered to the site of perforation . In the meantime re suturing of the wound was done with tensionless sutures . The patient was called again after 3 weeks of surgery to attempt endoscopic removal of the NG tube fixed to the pylorus . The knot was held with the biopsy forceps while gentle traction and rotatory motion was applied to the NG tube which slowly started slipping out of the knot and finally came out of it . The endoscopic cutter could have been used had the NG tube not come out with this effort . The site was checked for any signs of trauma / perforation or bleeding which were not present . The patient was kept on prophylactic antibiotics for 2 days and discharged there after. 


Accidental fixation of NG tube is a known complication of abdominal surgery but it is more common with laparoscopic procedures rather than open ones . Before applying the stitches at the site of perforation it is very important to lift up the anterior wall of the stomach or the intestine and make sure that any tube or probe is not coming along with the anterior wall of the stomach or intestine . So it is best to place a non tooth forceps into the perforation very gently so only the anterior wall comes up for stitching while the posterior wall or the tube stays out of the bite . 


Endoscopic technique is a feasible and safe minimally invasive  technique to release a retained nasogastric tube. This option gives major advantages of avoiding a re- operation, as well as the potential general anesthetic complications.

The approach to a case may be open or laparoscopic depending upon the situation and means available but stress should be laid upon the ways to prevent such inadvertent happenings from taking place rather than for measures to take when it has happened . 

Review of Literature

NG tubes may get fixed accidently in open aswell as laparoscopic or robotic surgery . Sucandy I et al used the endoscopic cutter for the retrieval of a retained NG tube following a robotically assisted laparoscopic biliopancreatic diversion with duodenal switch . They concluded that the endoscopic approach was better in terms of morbidity of the patient . Abu – Gazala S did a retrospective study on NG tube , temperature probe or bougie stapling during bariatric surgery in Israel and concluded that such complications occur more often than are reported . The treatment options may vary depending upon the place and the situation but a preventive strategy including constant communication with the anaesthetist is a more effective method so that the tube could be removed or relocated before stitching or stapling rather than pondering over post op strategies to remove the tube . Pequignot, A reported a case of stapled nasogastric tube in a 44 yo female undergoing bariatric surgery . In his case when the NG tube was removed by the nurse on the first post op day it was abnormally short and had staples at the lower end . Surgery had to be performed with pre operative endoscopy in this case . To prevent such mishaps from recurring he suggested the removal of Ng tube before the insertion of caliberation bougie into the stomach .

Shaaban, H reported a similar case in 2009 wherein the NG tube got stitched to the stomach accidently during laparoscopic anti reflux surgery and which was removed in a smilar way . 


1. Ronen, O. and N. Uri (2009). "A case of nasogastric tube perforation of the nasopharynx causing a fatal mediastinal complication." Ear Nose Throat J 88(9): E17-18.
2. Sucandy, I. and G. Antanavicius (2011). "A novel use of endoscopic cutter: Endoscopic retrieval of a retained nasogastric tube following a robotically assisted laparoscopic biliopancreatic diversion with duodenal switch." N Am J Med Sci 3(10): 486-488.
3. Pequignot, A., A. Dhahria, et al. (2011). "Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?" Case Rep Gastroenterol 5(2): 350-354.
4. Shaaban, H. and C. Armstrong (2009). "Nasogastric tube accidentally stitched to the stomach during laparoscopic antireflux surgery." Endoscopy 41 Suppl 2: E61.
5. Abu-Gazala, S., Y. Donchin, et al. (2012). "Nasogastric tube, temperature probe, and bougie stapling during bariatric surgery: a multicenter survey." Surg Obes Relat Dis 8(5): 595-600; discussion 600-591.
6. Santhanam, V. and M. Margarson (2008). "Removal of self-knotted nasogastric tube: technical note." Int J Oral Maxillofac Surg 37(4): 384-385.
7. Mohsin, M., I. Saleem Mir, et al. (2007). "Nasogastric tube knotting with tracheoesophageal fistula - a rare association." Interact Cardiovasc Thorac Surg 6(4): 508-510.
8. Liao, G. S., H. F. Hsieh, et al. (2007). "Knot formation in the feeding jejunostomy tube: a case report and review of the literature." World J Gastroenterol 13(6): 973-974.
9. Takwoingi, Y. M. (2009). "Inadvertent insertion of a nasogastric tube into both main bronchi of an awake patient: a case report." Cases J 2: 6914.
10. Agarwal, A., A. Gaur, et al. (2002). "Nasogastric tube knotting over the epiglottis: a cause of respiratory distress." Anesth Analg 94(6): 1659-1660, table of contents.
11. Arslantas, A., R. Durmaz, et al. (2001). "Inadvertent insertion of a nasogastric tube in a patient with head trauma." Childs Nerv Syst 17(1-2): 112-114.
12. Weinberg, L. and D. Skewes (2006). "Pneumothorax from intrapleural placement of a nasogastric tube." Anaesth Intensive Care 34(2): 276-279.
13. Johnstone, J. C., J. S. Leung, et al. (2011). "Nasogastric tube misadventures." Clin Pediatr (Phila) 50(10): 983-986.
14. Brousseau, V. J. and K. M. Kost (2006). "A rare but serious entity: nasogastric tube syndrome." Otolaryngol Head Neck Surg 135(5): 677-679.
15. Vielva del Campo, B., D. Morais Perez, et al. (2010). "Nasogastric tube syndrome: a case report." Acta Otorrinolaringol Esp 61(1): 85-86.
16. Wu, P. Y., T. J. Kang, et al. (2006). "Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis." J Formos Med Assoc 105(1): 80-85.

Source(s) of Funding

Not Applicable 

Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)