Dobhoff Detour: A Case Report of Unintended Biliary Cannulation and Persistent Pneumobilia after Passage of a Nasogastric Feeding Tube

Dobhoff tubes are small, flexible feeding tubes commonly used for enteral nutrition in critically ill patients. Although misplacement is known to occur, to our knowledge, direct displacement into the biliary tree has not previously been reported. We present a case of a patient with pneumobilia and a duodenal diverticulum noted on admission CT imaging. After Dobhoff tube placement, an abdominal radiograph suggested a peripyloric position; however, subsequent CT imaging revealed direct cannulation of the common bile duct with termination in the right hepatic duct. This malpositioning was associated with worsening pneumobilia and prompted immediate correction of the tube position. The pneumobilia persisted but gradually decreased over time. We believe that the patient’s duodenal diverticulum created an anatomic pathway that enabled the tube to enter the biliary system. To our knowledge, this is the first reported case of direct biliary cannulation by a nasoenteric feeding tube and underscores the importance of cross-sectional imaging when malposition is suspected.