Nasogastric tube feeding-induced iatrogenic empyema: a report of two cases and literature review
Year: 2025
Type: article
Study design: Case Report
Abstract: Background: The incidence of incorrect nasogastric tube (NGT) insertion into the trachea or distal airways is approximately 2%. When an NGT penetrates the visceral pleura and enteral feeding products are inadvertently administered into the lungs or thoracic cavity, severe chemical pneumonia and empyema can develop. Thus, confirming the NGT placement site before initiating feeding is crucial. Chest radiography (CXR) remains the gold standard for confirming NGT placement. However, enteral feeding products are often administered without prior CXR, leading to complications. This report describes two cases of iatrogenic empyema caused by incorrect placement of NGT in the thoracic cavity. Case Description: Case 1 was a 70-year-old man with a history of cerebral hemorrhage sequelae who was receiving NGT feeding. Routine NGT replacement was performed without CXR. Dyspnea developed following the administration of an enteral feeding product. Emergency CXR revealed incorrect NGT placement in the right thoracic cavity. The patient's circulation was stable, and he was managed with chest drainage. Case 2 involved a 95-year-old woman who was debilitated due to advanced age and was receiving NGT feeding. Routine NGT replacement was performed without CXR. Subsequently, she developed dyspnea and hypotension after the administration of an enteral feeding product. Emergency CXR and computed tomography revealed NGT placement in the right thoracic cavity, accompanied by a right pneumothorax and pleural effusion. As the patient was in shock, emergency surgery was performed following chest drainage. Both patients recovered successfully. Conclusions: Iatrogenic empyema induced by NGT feeding is a severe complication often resulting in respiratory failure. Prompt management with chest drainage is critical, and emergency surgery should be considered in cases of circulatory failure. To prevent such events, accurate evaluation of NGT placement via CXR before commencing feeding is imperative. Additionally, the indications for NGT insertion should be carefully assessed on a case-by-case basis.
Source: AME Case Reports
DOI: 10.21037/acr-24-294
Authors: Nobutaka Kawamoto, Shunsuke Morita, Masanobu Watari, Keizo Misumi
Institution: Hiroshima General Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414394549