An unanticipated failure of nasogastric tube placement due to peripancreatic collection: A case report

Abstract Nasogastric tube (NGT) placement is a very common clinical procedure in the emergency department (ED). The procedure is very simple, yet difficulties and catastrophes of misplacement are much more than reported. We hereby report a case of failure of the NGT placement in a patient with acute pancreatitis with a huge abdominal collection and its interesting solution. A 33-year-old male presented to ED with severe pain abdomen, abdominal distension, and shortness of breath. Abdominal examination showed a tense swelling in the upper abdomen with a grossly distended abdomen. Respiratory distress and fatigue were detected, warranting quick interventions. The reason for respiratory fatigue was figured out to be increased abdominal pressure resisting diaphragmatic pull down. As the abdomen was tense, NGT placement was to be done as part of routine care. Placement of the NGT was challenging, and multiple attempts failed to negotiate it beyond 35–40 cm, even with the best hands. An upper abdomen scan with ultrasonography (USG) point of care ultrasonography revealed hypoechoic images, likely a huge collection. A percutaneous drainage was planned immediately, a USG-guided pigtail catheter of 10 F was placed, and almost 2000 ml of fluid was aspirated. It was decided to push Ryle’s Tube (RT), and surprisingly, it was easily negotiable by now. After confirmation by the auscultation method, it was fixed at the 60 cm mark. In our case, there was compression of the stomach by the huge peripancreatic collection to the extent that there was no patent lumen to pass on anything.